Inspection on 12/10/05 for The Old Rectory Nursing Home

This inspection was carried out on 12th October 2005.

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

The inspector 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 Old Rectory Nursing Home 26/03/10

The Old Rectory Nursing Home 21/04/09

The Old Rectory Nursing Home 04/06/07

The Old Rectory Nursing Home 19/07/06

The Old Rectory Nursing Home 27/01/06

The Old Rectory Nursing Home 07/03/05

The Old Rectory Nursing Home 17/05/04

The Old Rectory Nursing Home 30/01/04

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

CARE HOMES FOR OLDER PEOPLE The Old Rectory Nursing Home, Exeter 45 Old Tiverton Road Exeter Devon EX4 6NG Lead Inspector Ms Rachel Fleet Unannounced Inspection 12th October 2005 09.50a 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 Old Rectory Nursing Home, Exeter DS0000026674.V256493.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 Old Rectory Nursing Home, Exeter DS0000026674.V256493.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Old Rectory Nursing Home, Exeter Address 45 Old Tiverton Road Exeter Devon EX4 6NG 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) 01392 431839 01392 253700 Southern Healthcare (Wessex) Limited Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places The Old Rectory Nursing Home, Exeter DS0000026674.V256493.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Staffing levels to be in place as agreed in the letter dated 23 June 2003 7th March 2005 Date of last inspection Brief Description of the Service: The Old Rectory Nursing Home is on the eastern side of the city of Exeter, in a residential area approximately one mile from the centre. The former Rectory - which dates back to 1875 - has been converted for its present use, but retains some original features. The Home accepts people over retirement age with general nursing needs. Accommodation for 44 residents is on three floors, although most bedrooms are on ground floor level. A shaft lift and platform lift provides level access within the home. A driveway leads up to a small area for car parking, with time-limited roadside parking available in the area. Mature trees screen the front of the building from the road below. There are well-tended gardens to the rear, with a pond and enclosed courtyard garden. There are two conservatory areas. A health centre, Anglican church, pub and local shops are relatively close, with a bus stop opposite the home. The Old Rectory Nursing Home, Exeter DS0000026674.V256493.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Rachel Fleet and Dee McEvoy (Regulation Inspectors) visited the home for just over seven hours. There were 41 residents accommodated there on the day. They spoke with 13 residents in some depth (as well as meeting with others), 4 relatives, 8 staff who were employed in different capacities, and two visiting health professionals, around the home. Some of these also completed CSCI comment cards. Documents and records were also reviewed, including five care plans and associated records used for case-tracking purposes. The visit ended with feedback of findings to Jane Werge, who manages the home Since the last inspection, CSCI has been contacted by a resident’s relative and a community health professional both of whom wished to inform us that they were very pleased with the care given at the home, the professional noting a great improvement. Southern Healthcare (Wessex) Ltd. has submitted an application for Jane Werge to become formally registered, as manager, with CSCI. What the service does well: When residents were asked what the home did best, three said the food was very good, as were the staff - who were described as kind, patient and considerate. One relative said, “Nothing is too much trouble for the staff.” A visiting health professional said, “I’m happy with the care here. It is excellent.” Prospective residents’ needs are carefully assessed to ensure the home can meet their existing needs should they be admitted to the home. Regarding care, wound care is very well managed. And there are good working relationships with various external health professionals who can give specialist advice to staff. A variety of activities and events are organised weekly for residents to take advantage of, if they wish to. Residents speak with the manager regularly, and feel any concerns are listened to. The accommodation provided is much appreciated, and the home’s cleanliness is of a very high standard. Staff were motivated and happy. They identified good standards of care and teamwork, and a “good working atmosphere” as strengths of the home. The Old Rectory Nursing Home, Exeter DS0000026674.V256493.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Some care records are of a good standard, but others need more detail and/or resident involvement to help staff meet those residents’ needs. Health care is generally very well given, and medication systems are good. But residents’ fluid intake needs better monitoring, and some practices relating to medications could be made safer. A balanced diet is provided; however, efforts need to be made to try to ensure it meets individuals’ preferences. To ensure care of the dying and arrangements after death are carried in the way each resident wants, they should be given the opportunity to discuss their wishes with staff. Residents feel staff respect their privacy, but this would be better promoted if bathrooms and toilets had door-locking devices. Action has been taken to try to ensure residents are protected from abuse. Relevant written policies should be freely available to staff, however. And better evidencing of decision-making is needed prior to using bedrails, to safeguard residents’ wellbeing. Staff have the skills to meet residents’ needs, but there are not always enough staff to ensure residents’ safety and overall wellbeing. Health and safety training is well managed, but staffing levels and other aspects of health and safety must be addressed to ensure the welfare of residents and staff. Residents and their representatives are involved in the running of the home, but quality assurance systems must be set up. Staff suggestions, for what could be done better, included training on care planning, more one-to-one time with residents, and more ‘multicultural’ understanding within the team (between staff from various countries overseas as much as with staff from this country). Laundry facilities were also identified as an area for possible improvement, in terms of space. The Old Rectory Nursing Home, Exeter DS0000026674.V256493.R01.S.doc Version 5.0 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 Old Rectory Nursing Home, Exeter DS0000026674.V256493.R01.S.doc Version 5.0 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 Old Rectory Nursing Home, Exeter DS0000026674.V256493.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Prospective residents’ needs are carefully assessed to ensure the home can meet their existing needs should they be admitted to the home. The home does not provide intermediate care. EVIDENCE: A pre-admission assessment was seen for a newly admitted resident, with relevant information obtained. The next-of-kin had been consulted, and had signed the initial care plan. A fuller care plan, with risk assessments, is completed during the first week or two. Another new resident confirmed they had been visited by someone from the home before being admitted there. The manager has contacted the Commission in the recent past to discuss whether or not the home can admit people with certain needs, showing that she is mindful that the home must be sure they can meet the needs of prospective residents before they are actually admitted. The Old Rectory Nursing Home, Exeter DS0000026674.V256493.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Whilst some care records are of a good standard, there is insufficient detail and/or resident involvement in others to ensure staff meet those residents’ needs. Health care needs are generally very well addressed, but fluid intake needs better monitoring. Medication systems are good. However, some aspects of practice do not ensure safe administration. Residents feel respected by staff; privacy would be better promoted if bathrooms and toilets had door-locking devices. The home is working towards providing very skilled nursing to the terminally ill and to the dying in their care. To ensure this care is given in the way the resident wants, residents should be given the opportunity to discuss their wishes with staff. EVIDENCE: All residents had care plans, which were based on a comprehensive template. Some did not include as much detail as others - social care needs (including residents’ interests), goals for individuals’ blood glucose levels or daily fluid intake where related needs had been identified, for example. Risk assessments need development to ensure that risks are identified and the action to reduce The Old Rectory Nursing Home, Exeter DS0000026674.V256493.R01.S.doc Version 5.0 Page 11 or manage risk needs to be clear. For example, aggressive behaviour was recorded in one resident’s notes and staff were aware of this, but no risk assessment or triggers had been completed. Behavioural and situational risks need to be developed. There was evidence that some residents had been involved in reviews of their care plans, but not all. Reviews were infrequent in some cases, and lacked detail. Contact with health professionals was documented (Tissue viability, GPs, Diabetic Nurse specialists, dietician and palliative care specialists, for example). Health assessment tools are used and regularly updated, but information thus obtained was not always used to inform care planning. Wound care is well managed. Fluid intake was less well managed – four residents during the inspection were not given the assistance they needed to have sufficient to drink, and relevant care records did not have sufficient detail. Medication systems were well established – with records of receipts, etc., newly required disposal procedures in place, good monitoring of Warfarin therapy, for example. Nurses have had related training recently. Some handwritten entries weren’t dated and signed by two staff to verify the accuracy of the entries. Drug fridge temperatures are noted daily; it is good practice to record maximum/minimum temperatures when insulin is kept is (as was found on this occasion). A bottle of medication, with a limited shelf life once opened, had not been dated (nor was there any other system in place) to ensure it was not used beyond the specified time limit. Recommendations were made at the last inspection regarding these points. A problem had recently arisen regarding storage of controlled drugs. A larger appropriate storage facility must be obtained if the problem is ongoing. Staff were sensitive and attentive towards residents. Residents’ comments included; “Staff are lovely, very kind”, “staff always listen to me” and “Staff are generally good.” The majority of relatives spoken with were happy with the overall care provided, saying staff were respectful. Residents felt their privacy was respected. One resident’s phone had broken; the home had lent them one till they could get theirs repaired, so they could still make calls from the privacy of their room rather than use the public payphone. Some communal bathrooms and toilets did not have door-locking devices, so a recommendation from the last inspection is carried forward. The home works with the local hospice to provide appropriate care for residents with palliative care needs, and were due to have relevant training from the hospice shortly. Staff visited one resident regularly during the inspection to give them care and comfort. Someone whose relative recently passed away at the home wrote to the Commission, saying how grateful they were for the excellent care given by staff prior to the death of their relative. Some care plans had residents’ wishes recorded regarding their care if their health deteriorated and arrangements after death. The Old Rectory Nursing Home, Exeter DS0000026674.V256493.R01.S.doc Version 5.0 Page 12 Others did not evidence whether this had been discussed or not. A recommendation from the last inspection report is therefore carried forward. One care plan did not include emotional or psychological support needed by one resident receiving palliative care, and there was no pain assessment tool. The Old Rectory Nursing Home, Exeter DS0000026674.V256493.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The range of activities available, visiting arrangements and links with the local community enrich residents’ lives. Staff promote residents’ exercise of choice and control. A balanced diet is provided, but efforts need to be made to try to ensure it meets individuals’ preferences. EVIDENCE: An activity is provided 3 or 4 times a week; the range of events includes aromatherapy, reminiscence, movement and exercise, and occasional outings. A visit by a donkey from the Donkey sanctuary had been much enjoyed. There is a small library. Residents are each given a written monthly activities programme. One resident said they enjoyed the musical afternoons and monthly communion service. The hairdresser visits 2 or 3 time a week; one resident said, “I like having my hair done.” One resident was less satisfied with the activities provided, but records showed staff were trying to address this. Residents mentioned visitors when speaking to the inspectors, and care records included when family had visited, etc. Visitors came and went freely throughout the inspection. One relative said, “The good thing about here is that you can come and go as you please.” Relatives said that they felt welcome at the home and were offered refreshments. The Old Rectory Nursing Home, Exeter DS0000026674.V256493.R01.S.doc Version 5.0 Page 14 Residents felt they felt they were given enough control over their lives. During the inspection, staff showed an understanding of residents’ needs and enabled choice whenever possible - for example, offering a choice at coffee time and lunch time. They interacted positively with the residents, providing encouragement and gentle intervention when needed. Some residents were happy with the food, and some were not. Comments included “It is excellent”, “It is very good”, “It is sometimes indifferent”. One said they didn’t like the taste of the food, but there was no choice so they had to eat what they were given. However, each bedroom had a file of information about meals, where it stated residents could request an alternative to the printed menu. The manager confirmed that alternatives are provided, if requested, and said she would check that the resident knew they could ask for something else. Two frailer residents said they didn’t like the food but couldn’t, at the time, specify what they didn’t like about it. A visitor who ate at the home regularly said the food was better than hospital food. One resident with gallstones said that they had a low fat diet supplied, and that her condition was well managed and she was symptom free. Menus were balanced. Pureed meals were appropriately presented. There is a kitchenette for residents’ use. The Old Rectory Nursing Home, Exeter DS0000026674.V256493.R01.S.doc Version 5.0 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The Home has a satisfactory complaints system, with evidence that residents feel their concerns would be listened to. Appropriate action has been taken to try to ensure residents are protected from abuse. The home’s written policy on protection of vulnerable adults should be freely available to staff, however. And better evidencing of decisionmaking is needed prior to using bedrails, to safeguard residents’ welfare. EVIDENCE: A majority of residents said they were visited by the manager regularly, and felt able to make a complaint if they wished to. The one who said they did not, felt they got on quite well with the staff and were very positive about them. The written complaints procedure provided in bedrooms contained required information. There were no complaints in the home’s log, and none were raised with the inspectors during the visit. A concern raised previously by a relative with the inspectors was discussed with the manager, who said she had spoken with the relevant person since then. Staff spoken with had undertaken training on protection of vulnerable adults, and were aware of their personal responsibilities with regards to reporting any concerns or incidents. Two nursing staff were generally aware of the procedure to follow in the event of an allegation. Local Authority guidance was available for staff. Photographs are displayed of various independently employed people that come into the home providing activities or other services to residents, etc. (the chiropodist and the ‘Sweet Man’, for example). The policy relating to protection of vulnerable adults could not be found; therefore a recommendation from the last inspection is carried forward. The Old Rectory Nursing Home, Exeter DS0000026674.V256493.R01.S.doc Version 5.0 Page 16 Care records relating to bedrails (a potential form of restraint) did not evidence multidisciplinary decision-making or what alternatives had been considered, etc. One resident had bedrails, but no risk assessment or consent had been completed. The Old Rectory Nursing Home, Exeter DS0000026674.V256493.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24 & 26 The standard of the environment within this home is good, providing residents with an attractive, clean, safe and homely place to live. Hand-washing facilities in the laundry need reviewing. EVIDENCE: The home appeared well maintained generally, both internally and externally. Residents liked their accommodation, including the garden, which has level access. They have been consulted individually as to whether they wish to have a door-locking device on their bedroom door. Quotes are still being obtained regarding provision of a shower facility. Residents were satisfied with the cleanliness of the home. A dedicated team of domestic staff ensure high standards are maintained, and there are no malodours. Disposable protective clothing is available for staff. The laundry is used for personal laundry only (sheets, towels, etc. are laundered externally). Machines have recommended programmes. The hand-washing facility is not easily accessible. The Old Rectory Nursing Home, Exeter DS0000026674.V256493.R01.S.doc Version 5.0 Page 18 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 There is an appropriate skill mix of staff, who care about meeting residents’ needs. But there are not always sufficient numbers to ensure residents’ safety and overall wellbeing. EVIDENCE: Residents and staff felt there were usually enough staff on duty. However, staff said they would like more one-to-one time with residents, to do more than just ‘basic care’ for them. There are two nurses on duty during the day, with 7-8 Care assistants, and 4-5 staff on duty overnight depending on the skill mix (-2 nurses 2 care assistants, or 1 nurse 4 care assistants). Care staff also have to do the laundry. During the inspection, staff were seen to be continuously undertaking various care-related duties. One resident said staff came quickly if they rang their bell. However, two residents said they had to wait for the call bell to be answered, but also said staff were hard working, and kind when they did arrive to help them. It emerged there is one area of the home where current residents have high levels of dependency, which means those individuals sometimes have to wait for their call bell to be answered because staff are attending to the other residents there. One of these residents had fallen while waiting for their bell to be answered. A visitor said there was a lot for each staff member to do, especially at busy times of the day, and they sometimes rushed personal care because of this pressure. The Old Rectory Nursing Home, Exeter DS0000026674.V256493.R01.S.doc Version 5.0 Page 19 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): 33 & 38 There are some systems for involving residents and their representatives in the running of the home, but external quality assurance systems are not established. Health and safety training of staff is well managed, but other aspects of health and safety must be addressed to ensure the welfare of residents and staff. EVIDENCE: Residents said there were no residents’ meetings, but that they spoke with the manager regularly. One said the residents were asked to ‘be honest’ with their opinions or views. Relatives’ meetings were held quarterly, one being due in November; surveys were given out in advance, and Mr Cox (the Responsible Individual for the home) dealt with any individual issues thus identified, on a one-to-one basis. Communication books provided by the home were seen in bedrooms, with messages to staff from visitors, requests for repairs, etc. the Commission has not recently received any monthly reports about the home from the Responsible Individual, nor ‘quality of care’ survey results. The Old Rectory Nursing Home, Exeter DS0000026674.V256493.R01.S.doc Version 5.0 Page 20 The manager uses a training matrix to ensure that mandatory training is up to date. Staff confirmed they had received training on fire safety and manual handling. Posters indicated other mandatory training was planned for November 2005. Fire safety checks were recorded at required intervals, apart from the fire alarms, which had been tested 2-3 times a month, rather than weekly as recommended by the local fire authority. The home is currently addressing issues raised by the local fire authority in August 2005. Window restrictors were in place where checked at random on upper floors. Accident forms were completed, but some lacked relevant details. Residents in bedrooms had call bells left with them. But residents in the ‘Oak’ sitting room did not have suitable access to a call bell, saying they waited till staff passed by if they needed something. Hot water where checked randomly at baths was a safe temperature. Some extractor fans in toilets and bathrooms were in need of cleaning and repair. Environmental risk assessments were not checked on this occasion, but maintaining a safe surface outside the front door was discussed, in view of fallen leaves, etc. with potential for creating a slippery surface when wet. The laundry is very small, and felt hot with all the equipment working, creating a difficult working environment. The Old Rectory Nursing Home, Exeter DS0000026674.V256493.R01.S.doc Version 5.0 Page 21 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X 2 X X 3 X 2 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X X X X 2 The Old Rectory Nursing Home, Exeter DS0000026674.V256493.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? NO 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 OP27 Regulation 18(1)(a) Timescale for action You must, with regard to the size 31/12/05 of the home, the number & needs of the residents, ensure that at all times suitably qualified, competent & experienced persons are working at the care home in such numbers as are appropriate for the health & welfare of residents. This is regarding adequate staffing levels in relation to residents’ dependency levels & needs. You must establish & maintain a 31/12/05 system for reviewing and improving the quality of care, including the quality of nursing, consulting residents & their representatives. And you must supply a copy of these reviews to the Commission, and make a copy available to residents. 31/12/05 The Responsible Individual (or their representative) must visit the care home unannounced at least monthly, including in the visit the actions indicated in Reg.26(4), and providing a copy of the report to those listed in Reg.26(5). DS0000026674.V256493.R01.S.doc Version 5.0 Page 23 Requirement 2 OP33 24 3 OP33 26 The Old Rectory Nursing Home, Exeter 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 OP7 Good Practice Recommendations It is recommended that all care plans include social care needs and contain adequately detailed information, to ensure that staff know what action to take to meet residents’ needs. And that reviews are monthly, include residents (or their representatives) where revisions are made, and reflect changing needs. It is recommended that fluid intake is better monitored, with relevant information included in care records and residents given the care they need to maintain an adequate intake. It is recommended that 1) hand-written entries on medication administration sheets are dated and signed by two staff, to verify the accuracy of the entries; 2) minimum and maximum readings of drug fridge temperatures be kept, when insulin is being stored; 3) a system should be established to enable monitoring of medications’ shelf-life once opened; 4) controlled drug storage be reviewed to ensure safe storage that meets legal requirements. It is recommended that all bathroom and toilets have appropriate locks. It is recommended that residents’ wishes concerning terminal care and arrangements after death are discussed and recorded. It is recommended that action be taken to try to provide an appealing diet in respect of individuals’ preferences. It is recommended that 1) the POVA policy be amended to ensure that it is in line with POVA guidelines/Alerters’ Guide, and that it be freely available to staff; 2) risk assessments and fully-informed consent should be evidenced when bed rails are used. It is recommended that there is a shower facility to enable service users to have a choice of washing methods. 2 OP8 3 OP9 4 5 6 7 OP10 OP11 OP15 OP18 8 OP21 The Old Rectory Nursing Home, Exeter DS0000026674.V256493.R01.S.doc Version 5.0 Page 24 9 10 OP26 OP38 It is recommended that hand-washing facilities should be prominently sited in the laundry. You should promote & protect the health, safety & welfare of residents & staff by ensuring that: 1) After consultation with the local fire authority, fire alarms are tested at required intervals; 2) Accident forms contain relevant details; 3) Residents in lounges have suitable access to a call bell; 4) Extractor fans are regularly maintained; 5) Risks relating to the size and temperature of the laundry are reviewed. The Old Rectory Nursing Home, Exeter DS0000026674.V256493.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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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