Inspection on 03/10/07 for The Poplars Nursing Home

This inspection was carried out on 3rd October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Poplars Nursing Home 23/01/07

The Poplars Nursing Home 24/06/06

The Poplars Nursing Home 10/01/06

The Poplars Nursing Home 02/08/05

The Poplars Nursing Home 09/03/05

The Poplars Nursing Home 22/09/04

The Poplars Nursing Home 01/12/03

The Poplars Nursing Home 09/07/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE The Poplars Nursing Home Rolleston Road Burton On Trent DE13 0JT Lead Inspector Mrs Yvonne Allen Unannounced Inspection 10:30 3 October 2007 rd 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 Poplars Nursing Home DS0000022360.V339906.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Poplars Nursing Home DS0000022360.V339906.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Poplars Nursing Home Address Rolleston Road Burton On Trent DE13 0JT 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) 01283 562842 01283 564642 Tawnylodge Limited Mrs Deborah Jane Watson Care Home 60 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (25), of places Physical disability (60), Physical disability over 65 years of age (60) The Poplars Nursing Home DS0000022360.V339906.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. PD Minimum age 60 years Date of last inspection 24th June 2006 Brief Description of the Service: The home is comprised of an extended two-storey building situated near to the town of Burton on Trent. The establishment provides personal and nursing care for elderly people with a bed capacity of 60. The home may also admit up to 5 people suffering with Dementia. There are forty-eight single and six shared bedrooms. Nineteen rooms have en suite facilities. The home has spacious accommodation, including 4 lounges on the ground floor and a further two upstairs. There is a bus service nearby and shops are nearby. The grounds and gardens are well maintained and provide easy access for wheelchairs. Weekly fees as from October 1st 2007 are from £285 up to £500 The Poplars Nursing Home DS0000022360.V339906.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection visit to the home and carried out by one inspector. The Registered Manager had completed an Annual Quality Assurance Assessment (AQAA) prior to this inspection visit. Contained in this was information required by the Commission for Social care Inspection (CSCI), thus helping to build a picture of the home of what it is like for the residents who live there. All the key standards were assessed and the following methods were used to obtain the evidence required in order for us to make judgements on each outcome – Direct observation of care practices Discussions with residents about their views on the home Discussions with the staff who work at the home Discussions with the registered manager of the home A tour of the home, including all the communal areas and a selection of bedrooms Examination of relevant documents and records The inspection visit was carried out over 1 day and took about 5 hours to complete. We were made to feel welcome by all the staff and residents in the home. What the service does well: The home provides positive outcomes for the residents who live there. The following comments were documented in surveys, which had been completed by relatives – “The home is quiet and peaceful with wonderful staff.” “There is a warm and friendly atmosphere.” “I feel that my Father is safe and looked after.” It is a well managed home which is run in the best interests of the residents and the views and opinions of individuals are actively sought and taken into account. Personal and nursing care is delivered with dignity and respect and the home is welcoming and friendly and the people who live there feel happy, well cared for and valued. The Poplars Nursing Home DS0000022360.V339906.R01.S.doc Version 5.2 Page 6 Healthcare needs are assessed and monitored and access to specialist services is actively sought for those who need it. The social and therapeutic needs of the residents are met and individuals are encouraged to maintain interests and hobbies. Regular outings are arranged to local places of interest. Families and representatives are encouraged to join in with organising events and the atmosphere created is that of one big family. The staff who work at the home are carefully selected and possess the necessary skills and expertise to meet the needs of the residents. Staff training is good and staff are supported to meet their training needs. Any concerns, which individuals might have about the home, are listened to and dealt with quickly. Diverse needs are acknowledged and met and staff go out of their way to ensure that residents are treated as individuals as much as possible. What has improved since the last inspection? The quality and consistency of individual plans had improved and care plans were found to be thorough and comprehensive. There is regular consultation with the residents about their opinions and thoughts, and this is published. Staff training in dementia awareness and the ability of the staff at the home to meet the specific needs of residents with this illness has improved. The staff training and development programme has improved and NVQ training has been stepped up at the home. All staff have attended training sessions in the Protection Of Vulnerable Adults (POVA). The complaints procedure has been updated and distributed accordingly since the last inspection. A new Optician service has been introduced by the home and is benefiting the residents who live there. There has been a new activity co-ordinator employed at the home since the last inspection. This has improved the activities and entertainment programme delivered to residents in the home. The Poplars Nursing Home DS0000022360.V339906.R01.S.doc Version 5.2 Page 7 Some redecoration and refurbishment had taken place in the last 12 months. This has included the following areas - the front lounge, the dining room and the residents’ lounge on the second floor. The moral of the staff team has improved and staff turnover has settled down. The frequency of staff fire drills has improved with all staff now receiving regular drills. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Poplars Nursing Home DS0000022360.V339906.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Poplars Nursing Home DS0000022360.V339906.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,3 and 4 were assessed. Standard 6 does not apply, as the home does not accept residents for intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives are given the necessary information about the home in order to be able to make a decision about moving in. Residents can be assured that the staff at the home will meet their assessed needs. EVIDENCE: The Poplars Nursing Home DS0000022360.V339906.R01.S.doc Version 5.2 Page 10 A random selection of 4 care plans was examined during which it was established that residents had undergone an assessment of their needs before being offered a placement at the home. The manager confirmed that these assessments were usually carried out by herself, or, in her absence the deputy manager or another first level nurse. She also confirmed that only residents whose nursing and/or care needs fell into the category of care for which the home is registered, are accepted. Where an authority funded residents then a suitably qualified individual had also assessed their needs and these were contained in care plans. The manager states in the AQAA that “relatives are encouraged to drop in and look around without needing an appointment” and that “local Social Services Care Mangers know that staff can cope well with emergency admissions from the community due to previous experiences”. The home’s Statement of Purpose and Service User Guide were available in each bedroom and there had been no major changes to these since the last inspection. The Poplars Nursing Home DS0000022360.V339906.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual care is planned and delivered with dignity and respect and health and personal care needs are monitored and met. EVIDENCE: The same 4 individual care plans were examined in detail in relation to the meeting of health and personal care needs. Without exception all the care plans were up to date and fully completed. Plans were individual and took into account personal wishes and preferences and these were documented. This confirmed what the manager had stated in The Poplars Nursing Home DS0000022360.V339906.R01.S.doc Version 5.2 Page 12 the AQAA – “All residents are treated as individuals. Their preferred routine is established on admission.” Several residents were spoken to during the inspection visit and all, without exception, confirmed that they felt well cared for by the staff at the home. Comments included – “The staff are lovely and very caring” and when one lady was asked if she felt safe at the home she replied “oh yes very safe and secure here” – other residents were nodding in agreement as they overheard the conversation. The healthcare needs of individuals were met at the home. There was evidence of visits by the GPs and the manager states – in the AQAA – “GPs visit as soon as possible following admission to establish a baseline of physical and mental health”. The home did not have any residents with pressure sores at the time of the inspection visit but assistance is at hand if needed from the Tissue Viability Nurse Specialist who will come out to assess individuals if required. This is a home for life and the staff at the home can also access the support of the Palliative Care Nurse Specialist if required. Some of the nurses also have received training in this area. There was evidence of visits by opticians, chiropodists and other healthcare professionals and individuals were supported to attend outpatient clinics. Individuals admitted for personal (residential) care received visits by the District Nurses as and when required to help meet their health care needs. The manager showed us a cupboard, which the district nurses, used for storage purposes. Care plans had been evaluated regularly and individuals and/or representatives were given the opportunity of participating in these evaluations and reviews. The care planning system had improved considerably since the last inspection. We met with one elderly gentleman who had some quite diverse physical and psychological needs. His plan of care reflected the care seen delivered to him on that day. He was sat in the smoking room – where he preferred to sit and have his cigarettes. He was using a specially adapted wheelchair and the care assistant was observed attending to him –and trying to make him more comfortable. He possessed a good sense of humour and it was observed that, at times, his psychological needs proved challenging for the staff at the home. However, staff were observed to be patient and caring and attentive to his needs. There was a medication policy in place. Downstairs, on the residential unit, senior care assistants were responsible for administering medication to individual residents. These members of staff had undergone a recognised medication-training course and certificates were in place to evidence this. Upstairs on the nursing unit trained nurses administer medication and part of this process was observed during the inspection. Discussions with the nurses on duty at the time of the visit identified that they had a sound knowledge of the medication policy and procedures. One of the The Poplars Nursing Home DS0000022360.V339906.R01.S.doc Version 5.2 Page 13 nurses explained the method used for disposal of controlled medication by use of a “doom container” which is witnessed and signed for by 2 nurses. Residents were able to self-administer medication if they wish to following a suitable risk assessment. Privacy and dignity are very much promoted by the staff at the home. The manager states in the AQQA – “Staff actively promote the residents’ well being by being taught to show respect and continuing to create a good sense of ethics amongst the workforce. All residents wear their own clothes. End of life care is delivered with empathy and relatives needs respectfully met.” The Poplars Nursing Home DS0000022360.V339906.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The routine of the home is made flexible and individuals are helped to exercise choice and control. There is a need to improve the choices and quality of the meals provided and to ensure that nutritional needs are being met. EVIDENCE: There was a planned programme of activities and entertainment in the home and an activities co-ordinator was employed part time. There were photographs up on the walls of trips out and activities which the residents had enjoyed throughout the year. Residents were encouraged to continue with previous hobbies and interests. Individuals spoken to stated that they were happy with the activities on offer at the home. The Poplars Nursing Home DS0000022360.V339906.R01.S.doc Version 5.2 Page 15 The manager states in the AQAA – “there is no such thing as home routine – each day is very different”. “Care is focussed on each individual rather than task-led.” “Close links with community groups who visit frequently” and there is “open visiting”. There was a good atmosphere noted at the home and a good rapport between staff and residents. The atmosphere was friendly and homely. Records and documentation of activities were examined. These had been recorded for individuals. There was an open visiting policy in place and visitors were observed coming and going throughout the visit. One visitor was spoken to at the time and commented that they were happy with the care and services provided and had no concerns. The menus were examined and the lunchtime meal was observed. The quality of the food served was only adequate and somewhat repetitive. There is a requirement in place to obtain an assessment of the menus from a recognised dietician/nutritionalist. Following this there should be a review of the menus. There were some negative comments received from individual residents in reference to the meals provided – “The meals are a bit boring” and when one resident was asked what the meals were like in the home the reply was “only middling.” Some residents were quite happy with the meals and stated that they were “very good”. It was noted that residents who were dining on the second floor had to wait for hot meals, as there was no hot trolley provided to transport these and the meals were having to be sent up from the kitchen in the dumb waiter. It is recommended that a hot trolley be provided for this purpose. The Poplars Nursing Home DS0000022360.V339906.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected from harm by the policies in place at the home and can be assured that any concerns they have will be listened to and acted upon. EVIDENCE: The CSCI had not received any concerns or complaints about this home over the last 12 months. The manager maintained a complaints and concerns log and this was examined at the time of the visit. She explained that she deals with concerns raised quickly and effectively to ensure that they do not grow into complaints. There was evidence of how she had dealt with these and her responses and action taken. There was a complaints procedure displayed in the entrance hall. The complaints procedure has been updated and distributed accordingly since the last inspection. The Poplars Nursing Home DS0000022360.V339906.R01.S.doc Version 5.2 Page 17 There was also a suggestion box in the entrance hall for anonymous ideas. The manager of the home was approachable and residents, staff and a visitor all confirmed this and that they could go to her should they have any concerns. There were policies and procedures in place at the home to help ensure that residents were kept safe. These included the robust recruitment procedure ensuring that all staff underwent police checks and reference checks before being employed to work at the home. The home also had a Vulnerable Adults policy in place and there was evidence that staff had received training in this area. Staff members spoken to confirmed that they were aware of what to do and how to report suspected abuse. There was also a Whistle blowing Policy in place at the home. The Poplars Nursing Home DS0000022360.V339906.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a secure and comfortable environment, which is homely in character. The fabric of the home is now looking worn in areas and is in need of updating. EVIDENCE: A tour of the home was conducted during which all of the communal areas and a random selection of bedrooms were inspected. The Poplars Nursing Home DS0000022360.V339906.R01.S.doc Version 5.2 Page 19 The home was looking worn and tired and in need of redecoration and refurbishment. No significant improvements had been made to the environment since the last inspection and the need for this is now great. Many of the rooms inspected would benefit from redecoration, refurbishment and recarpeting. The carpet in bedroom 22 was particularly poor and it is required that this be replaced within 1 month. There were some urgent requirements left at the time for the Providers to address. These were to make safe the join running along the carpet in the corridor area outside toilet number 3 as this posed a tripping hazard. This was done at the time of the visit. There was a similar tripping hazard along the carpet outside room 40 and this too was made safe at the time of the visit. Some of the mattresses on the beds were also looking worn and it is a recommendation that a mattress audit and replacement programme is put into place at the home. The laundry room was particularly untidy and dusty and in need of a through clean There was an accumulation of dust behind the dryers – this posed a fire hazard, and there was an urgent requirement left to clean this area. The kitchen was inspected and found to be clean and tidy and there were cleaning schedules in place. It was noted that cups were being used without saucers and it is a recommendation that, in order to promote dignity for individuals, saucers be used with the cups. The remainder of the home was clean and there were no mal odours noted throughout. The Poplars Nursing Home DS0000022360.V339906.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are carefully selected, supplied in sufficient numbers, and possess the necessary skills in order to meet the needs of the residents accommodated in the home. EVIDENCE: At the time of the inspection visit there were 34 residents accommodated, 16 of whom were in receipt of nursing care, 16 receiving residential care and 2 with dementia care needs (residential). The manager was working supernumery in her management role and there were 2 other trained nurses on duty – 1 on each floor. There were three care assistants on the ground floor (residential) and 4 on the nursing floor. Discussions with the staff and observations at the time identified that the dependency on the second floor (nursing) was medium to high with a need for another care assistant during the busy morning shift. The Poplars Nursing Home DS0000022360.V339906.R01.S.doc Version 5.2 Page 21 Ancillary staff were provided – 1 laundry assistant daily, 3 domestic staff daily and one full time maintenance person. The kitchen was staffed by 1 cook and 1 kitchen assistant and then an evening kitchen assistant until 6pm. An administrator was employed full time and a part time activities person. 4 employee files were checked and were found to contain all the required information essential for protecting residents in the home. Criminal records checks had been done and staff had been checked against the Protection of Vulnerable Adults list. 2 written references had also been obtained. Employment history had also been checked and explored. Individual records and certificates of training were in place. This had also included mandatory health and safety training. Staff spoke to confirmed that they had received regular update sessions in mandatory training such as moving and handling, fire safety and infection control. There was also documentation of other pertinent training having taken place and nurses were undertaking dementia awareness training. NVQ training is underway with 55 of care staff trained to NVQ level 2, 8 more care staff undertaking the award and 3 domestic staff were also on an NVQ course at the time of the visit. The manager states in the AQAA – we have “settled staff – low staff turnover rate and excellent skill mix of staff” and “a positive attitude towards training by all staff”. The Poplars Nursing Home DS0000022360.V339906.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33, 35, and 38 were assessed Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run and managed in the best interests of the people who live there. EVIDENCE: Discussions with the staff and residents of the home confirmed that the manager was competent and approachable. She ran an open door policy. The Poplars Nursing Home DS0000022360.V339906.R01.S.doc Version 5.2 Page 23 As the AQAA states – “The Registered Manager is a qualified nurse who has attained NVQ level 4 in Business Management and the Registered Managers’ Award.” The overall management of the home was very good and residents and staff felt supported. Quality auditing is on going at the home and evidence of this was seen at the time of the visit. The following comments were obtained in a satisfaction survey done in march 2007 – “ Quiet and peaceful with wonderful staff” and “warm and friendly atmosphere” and “I feel that my father is safe and looked after”. There was a stakeholders’ survey done in May 07, an audit of staff records done in February 07 and an audit of residents’ personal allowances done in June 07. The manager stated that she runs regular meetings for staff and residents/relatives but the latter is not always very well attended. Minutes of these were seen. Residents confirmed that their opinions are listened to and that if they had any suggestions about the home these are “taken on board”. The AQQA states – “Service delivery is subject to frequent reviews and based upon opinions from residents, staff, relatives and other visitors to the home.” The maintenance of personal allowances was examined and this was found to be in order. There were clear audit trails in place. A total of 4 personal allowances were checked at the time. There is a health and safety policy statement in place at the home and the manager ensures the health and safety of the residents, staff and visitors. Examination of records and documentation confirmed that these were up to date for maintenance and servicing of equipment including fire detecting and fire fighting equipment. The records relating to the maintenance, servicing and testing of equipment were well organised and thorough and a credit to the maintenance person. The fire alarm system had been regularly checked, as had the emergency lighting throughout the home. Regular fire drills had been held. The home had received a visit from the fire safety officer in April 07 where his recommendation had been addressed. Environmental Health had visited the home on 13/03.07 and the recommendations outlined in their report had since been addressed. The Poplars Nursing Home DS0000022360.V339906.R01.S.doc Version 5.2 Page 24 The Poplars Nursing Home DS0000022360.V339906.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x 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 3 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 The Poplars Nursing Home DS0000022360.V339906.R01.S.doc Version 5.2 Page 26 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 OP38 Regulation 13(4) Requirement The join along the carpet located outside toilet number 3 and the hole in the flooring outside bedroom number 40 which pose a tripping hazard must both be made good. The build up of dust located behind the tumble dryers in the laundry room, which poses a fire hazard, must be removed. There must be a mattress audit and replacement programme put into place at the home. This must include timescales. The carpet in bedroom 22 must be replaced. Advice must be obtained from a dietician in relation to the current menus. The menus must be revised following this assessment. There must be a programme of redecoration and refurbishment for the home put into place and provided to the CSCI and this must include timescales. Timescale for action 25/10/07 2 OP38 23(4) 25/10/07 3 OP24 16(2)(c) 25/11/07 4 5 OP19 OP15 23(2)(b) 16(2)(i) 25/11/07 25/11/07 6 OP19 23(2)(b) 25/11/07 The Poplars Nursing Home DS0000022360.V339906.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP10 OP27 OP15 Good Practice Recommendations Saucers should be provided with drinking cups in order to ensure dignity for the residents who live at the home. There should be another care assistant working on the nursing unit on the morning shift A hot trolley should be supplied so that meals can be safely and more easily provided for residents on the top floor The Poplars Nursing Home DS0000022360.V339906.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection 1st Floor Ladywood House 45-56 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Poplars Nursing Home DS0000022360.V339906.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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