Inspection on 12/02/08 for The Sidcup Nursing And Residential Centre

This inspection was carried out on 12th February 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Sidcup Nursing And... 11/12/08

The Sidcup Nursing And... 13/03/07

The Sidcup Nursing And... 29/11/05

The Sidcup Nursing And... 12/05/05

The Sidcup Nursing And... 24/11/04

The Sidcup Nursing And... 13/05/04

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

CARE HOMES FOR OLDER PEOPLE The Sidcup Nursing And Residential Centre 2-8 Hatherley Rd Sidcup Kent DA14 4BG Lead Inspector Lorraine Pumford Unannounced Inspection 12th February 2008 09:30 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 Sidcup Nursing And Residential Centre DS0000006769.V359305.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 Sidcup Nursing And Residential Centre DS0000006769.V359305.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Sidcup Nursing And Residential Centre Address 2-8 Hatherley Rd Sidcup Kent DA14 4BG 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) 020 8300 7711 020 8300 7799 matthbev@bupa.com www.bupa.co.uk BUPA Care Homes (ANS) Ltd Mrs Jane Brock Care Home 100 Category(ies) of Old age, not falling within any other category registration, with number (90), Physical disability (10) of places The Sidcup Nursing And Residential Centre DS0000006769.V359305.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing (CRH - N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 90) 2. Physical disability - Code PD (maximum number of places: 10) The maximum number of service users who can be accommodated is: 100 13th March 2007 Date of last inspection Brief Description of the Service: The Sidcup Nursing and Residential Centre is owned by BUPA. The ground and first floors are for the general nursing care of 71 residents. The second floor provides care for 29 older people who have been assessed as requiring residential care as apposed to nursing. All the bedrooms in the home have ensuite facilities and there are assisted bathrooms on each floor. There are communal sitting and dining areas and an enclosed garden. The home is very close to Sidcup High Street where there are a variety of shops and access to local buses. The Sidcup Nursing And Residential Centre DS0000006769.V359305.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star this means that people using the service receive an adequate service. Prior to undertaking this visit the provider was asked to complete its first Annual Quality Assurance Assessment (AQAA). This unannounced Key inspection was undertaken by three inspectors who spent a day in the home. During that time a number of staff and people who live in the home were spoken with. Prior to this visit a number of surveys were sent to people living in the home and their relatives to ascertain their views. Fifteen were returned and their comments have been incorporated into this report. During the course of the day a number of policies and procedures were examined in relation to recruitment and training of staff as well as health and safety and parts of the premises inspected. Fees range from £745 for residential care to £955 for nursing care. What the service does well: Prospective residents are provided with sufficient information about the home. Prospective residents benefit from a comprehensive pre admission assessment. There are regular newsletters distributed, which people living in the home and their relatives find helpful and informative. Residents can be assured that their privacy and dignity will be respected. People admitted to the home on a respite basis are able to retain their own GP. Residents benefit from a varied nutritional diet. Residents benefit from being able to exercise choice and control on a day-today basis. Sound recruitment procedures help to protect people living in the home from harm. Residents benefit from receiving care from staff that are suitably qualified. The Sidcup Nursing And Residential Centre DS0000006769.V359305.R01.S.doc Version 5.2 Page 6 People living in the home benefit from living in a clean, comfortable home like environment. Residents benefit from living in a home that is well run and managed. Residents living in the home can be assured that BUPA will monitor the care and service provided. What has improved since the last inspection? 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 Sidcup Nursing And Residential Centre DS0000006769.V359305.R01.S.doc Version 5.2 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 Sidcup Nursing And Residential Centre DS0000006769.V359305.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are provided with sufficient information about the home and benefit from a comprehensive pre admission assessment. EVIDENCE: All of the people living in the home and relatives who completed a CSCI survey stated they had been provided with enough information regarding the home when they were thinking about moving in. Some people also commented on the fact that there are regular newsletters distributed, which they find helpful and informative. Since the last inspection the home has implemented a new assessment and care plan format which is comprehensive. This includes an index of the contents which makes it easier for people using the system to locate the relevant information needed promptly. The Sidcup Nursing And Residential Centre DS0000006769.V359305.R01.S.doc Version 5.2 Page 9 A requirement was made at the time of the last inspection regarding the need for a comprehensive assessment to be undertaken in relation to any person being admitted to the home. A total of six files were examined in relation to the assessment process. There was evidence that an initial assessment had been undertaken in relation to all of the people admitted to the home. Record seen in relation to one person who generally resides on Knoll unit indicated that the person had been in hospital for a number of weeks and had recently returned. Generally it is good practice to undertake an assessment prior to the person returning home to ensure that staff are still able to meet an individuals needs and if necessary update the care plan however, in this instance the manager agreed for the person to return home without an assessment being undertaken (see standard 7). Apart from one person all of the people who completed surveys felt that the care home met the needs of their relative. The Sidcup Nursing And Residential Centre DS0000006769.V359305.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans provide staff with guidance on how to meet residents assessed needs, however residents would benefit if these were developed further. Residents can be assured that their privacy and dignity will be respected. Staff must follow medication procedures in order to safeguard people living in the home. EVIDENCE: A total of six care plans were examined across the three units. The format is comprehensive. There was evidence risk assessments are completed in relation to moving & handling, falls and pressure sore development. Generally care plans showed how risks were to be managed and care needs met. A requirement was made at the time of the last inspection regarding the need for risk assessments to be completed for people needing to use wheelchair lap belts. One resident sitting in the Hatherley lounge had a seat belt on when using a wheelchair but on looking at the person’s care records there was no The Sidcup Nursing And Residential Centre DS0000006769.V359305.R01.S.doc Version 5.2 Page 11 risk assessment in place and use of the belt was not referred to in the care plan. A requirement was made at the time of the last inspection that care plans should provide staff with guidance on how to manage residents who exhibit aggressive behaviour. Records for one of the samples seen indicated the behaviour of a person continues to upset other people, however there was no evidence that this had been addressed in their care plan. Record seen indicated that relatives were involved in the review process and this was confirmed by people who completed surveys, however the care plan for one person living on Knoll units indicated that although they did not have any communication difficulties they had not been included in the review process. The unit manager stated that whenever possible residents are always involved in the process and stated that care plans would reflect this in future. Staff use the Malnutrition Universal Screening Tool MUST system of assessing peoples nutritional needs. Record seen for one person on Grandville unit indicated the person had lost weight and the persons GP had been informed of this, however issues arose in relation to the MUST assessment for some people. The records pertaining to one person who had returned from a stay in hospital indicated that staff noted the person had visibly lost weight and this was confirmed when weighed. However, the person was not reassessed, or the care plan updated nor the GP informed. Another resident was assessed as being nutritionally at risk, however did not have a care plan in relation to this and had not been weighed on admission. In another instance a resident had a fluid intake chart in their bedroom but this had not been kept up to date and the fluid intake not totalled daily. Action must be taken to address these issues. All residents are registered with a GP and records seen show that staff support residents to access other health care such as dental, optical and chiropody and a number of respite residents admitted to Hatherly unit have remained registered with their GP during their stay in the home. Since the last inspection BUPA have appointed a Tissue Viability Nurse who is available for consultation and has trained four staff in this field of expertise. Records for the residents seen indicated that one of the sample had a pressure area. The care plan for the pressure sore was satisfactory and in addition the person had been provided with appropriate pressure relieving equipment. A policy and procedure was provided in relation to medicine management. This was quite comprehensive, available to staff and had been reviewed in December 2006. Adequate storage facilities are provided and a medicine trolley used to administer medicines. The Sidcup Nursing And Residential Centre DS0000006769.V359305.R01.S.doc Version 5.2 Page 12 It was noted and staff confirmed that they started the morning medicine round at 08:15 and did not finish till about 11:00 am. The afternoon medicine round was started at 12:30 pm. Therefore the gap between medicine doses administered may not be adequate. Management must review this and resolve the issue. Records were kept for receipt, administration and disposal of medicines. Preprinted administration charts were used and satisfactory identification in place for residents. Medicines checked for residents using the pre-packed dosage system were correct but there was no evidence to show that topical preparations or nutritional supplements prescribed had been administered. However the medicines for respite residents are not as safely managed. For example staff transcribed these on to the administration charts but the entries did not reflect the guidance on the pharmacy label and the entry was signed by only one person, staff had transferred a number of doses of one medication from one container to another, a stock of medicines for one resident were not given for about a week as there was none in stock and the number of doses of medicines bought in by respite residents was not recorded or brought forward on administration charts so it was not possible to complete an audit trail. Homely remedy medicines were used in the home. The homely remedy stock of Paracetamol could not be found. Records relating to residents medication was seen in relation to the documentation being audited for two people on Knoll unit. This indicated that staff were recording a resident as refusing medication when in fact the person was declining to take medication that had been prescribed as PRN and was not needed. At the time of another residents admission to the home a member of staff had incorrectly recorded a persons medicine as 75 mg when it should have read 7.5 mg. The unit manager amended this immediately. Other issues discussed with manger were the need to have a medicine profile for each resident with evidence of regular medicine reviews. The need to have protocols in place for administration of ‘as required’ medicines such as pain relief for residents with poor or no communication skills. Staff said they receive medicine management updates every two years however staff responsible for medicine management need to be assessed annually as being competent to do so. Some of the staff had attended ‘end of life care programme’ training and spent time at the local hospice. The home uses the ‘Liverpool Care Pathway’. This model of care aims to provide improved quality of care for people that are nearing the end of their lives. Some of the records included information about people’s wishes to remain in the home to die and about their funeral arrangements. The Sidcup Nursing And Residential Centre DS0000006769.V359305.R01.S.doc Version 5.2 Page 13 Staff spoken with had a good understanding of resident’s needs and were observed interacting in a pleasant and relaxed manner with residents. Residents were well presented with male residents shaven and female residents well dressed wearing make up and jewellery. Residents spoken with were satisfied with the way staff treated them comments made included “the staff are very good”. The Sidcup Nursing And Residential Centre DS0000006769.V359305.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a varied nutritional diet. Residents quality of life is enhanced by opportunities to participate in a range of social and recreational activities. Residents benefit from being able to exercise choice and control on a day-to-day basis. EVIDENCE: A recommendation was made at the time of the last inspection regarding the need to make activities more appropriate and accessible for people living in the home. Since then an additional activities coordinator has been employed. The activity coordinators work nine to five, weekdays however they also work at weekends to cover special events. Information regarding activities was displayed on each unit. There is a designated activities room and in addition activities also take place on units around the home. On the day we visited a female vocalist was providing entertainment for residents on one unit although people living in other parts of the home who wished to listen had been assisted to the lounge for the performance. Residents were also enjoying Pat-thedog. The Sidcup Nursing And Residential Centre DS0000006769.V359305.R01.S.doc Version 5.2 Page 15 The activity co-ordinator spoken with stated that a training day was being arranged for activity co-ordinators that worked for the company. She stated that they are provided with a monthly budget. At present craft activities are popular and additional equipment has been purchased for residents wishing to join in. In addition armchair exercises, quizzes etc are also arranged. Residents spoken with stated they were happy with the activities provided which was a positive response compared to the last time we visited the home. BUPA has a Monthly Activity Monitoring Form which staff complete when residents have participated in various activities. Whilst some of these were self explanatory i.e. spiritual needs there was no indication what other terms such as self engaged and multi needs activity meant. This system does not provide any room for staff to record if residents have enjoyed participating in certain activities, which would be helpful in terms of improving the quality of life for some people who have memory loss and are unable to express their preference. The majority of the sample seen had not been regularly completed and there were only intermittent entries in care plans seen. Discussion took place with the manager regarding the need for all staff to take on the responsibility of recording this information. Residents spoken with were satisfied with the visiting arrangements and said they enjoyed seeing family and friends. Six relatives were seen and agreed with this comment. Visitors also said that they were made feel welcome and were offered a cup of tea. The nurse on duty on Hatherley was observed taking a call from a relative and when the call ended went to tell the resident about the call. A relatives on Granville unit said staff always kept her informed about important issues, other relatives who completed CSCI surveys reiterated this. Residents spoken with stated they are able to choose if they wish to spend time in their bedroom or lounges and how they wish to spend their day. Residents spoken with stated they had been able to bring in pictures mementos and small items of furnishings from home to personalise their bedrooms. Lunchtime was observed on all three units. Tables were properly laid for the meal and a choice of fruit squash provided. The daily menus were displayed, residents said the menu was generally followed. Staff assisted residents with their meal and a choice of meals was offered. Comments about food varied with some residents saying it was good and others saying it was not bad or it was ok. Meals were covered when being taken to resident bedrooms. Lunch was served at around 12.30 pm however on all three units staff were assisting residents to tables much earlier than this and in some instances people waited 45 minutes before being served their meal. On Granville unit two people fell asleep whilst waiting for their meal to be served. The Sidcup Nursing And Residential Centre DS0000006769.V359305.R01.S.doc Version 5.2 Page 16 One of the kitchen staff was seen on Knoll unit checking the temperature of food being served and talking to residents about the meal. One person stated they had a hospital appointment the following day and requested that lunch be provided early and the member of kitchen staff confirmed that this would be arranged. The Sidcup Nursing And Residential Centre DS0000006769.V359305.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The provider must ensure that staff follow complaint and adult protection procedures correctly so that residents and other stakeholders can be confident that any concerns they have will be addressed appropriately in order to safeguard people living in the home. EVIDENCE: Information provided the time of inspection indicates the home has a comprehensive complaints procedure; the policy includes a three-tier framework commencing with the centres manager, the regional management team and the national quality and compliance department. A copy of the complaints procedure is displayed in the home. All of the relatives who completed surveys stated they were aware of the complaints procedure. All the residents who completed surveys stated they were aware of the complaints procedure or would discuss any concerns with their relatives and ask them to raise concerns with the manager on their behalf. Records seen indicate that seven complaints have been made to the manager in relation to either the care or service provided. Although the manager generally maintains a log in relation to issues brought to her attention and the action taken to address the matter, information in relation to the investigation of one of the complaints could not be found. The manager stated that this would be located and forwarded to the CSCI. To date this is not taken place. The Sidcup Nursing And Residential Centre DS0000006769.V359305.R01.S.doc Version 5.2 Page 18 Information provided at the time of inspection indicates that the provider has a comprehensive policy in relation dealing with any allegation of abuse or neglect. In the last twelve months there have been five incidents addressed under the local authority safeguarding adults procedures. In the absence of the manager staff undertook an internal investigation in relation to one incident and the matter was belatedly referred to the local authority. This matter was raised with the provider and appropriate action taken to prevent this from reoccurring. Records seen indicate that the majority of staff working in the home have undertaken appropriate training in relation to adult protection. Staff spoken with clearly stated the action they would take if they had any cause for concern in relation to this issue. The Sidcup Nursing And Residential Centre DS0000006769.V359305.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home benefit from living in a clean, comfortable home like environment. EVIDENCE: All three floors seen were clean and tidy and odour free. Bedrooms seen were clean tidy and personalised. Residents spoken with and people who completed surveys stated they were satisfied with the cleanliness of the home. Some maintenance issues were discussed with the Centre manager. On Hatherley unit a corridor wall would benefit from repainting. In the bathroom opposite the shower room the pipe boxing by the toilet required repair and repainting, as it was no longer waterproof, the shower room was very cluttered (4 hoists, 3 wheelchairs, 2 commode chairs and sit on scales.) Also in this room the pipe boxing needed repair and repainting. The bathroom near the dining room was also quite cluttered with a pressure relief mattress The Sidcup Nursing And Residential Centre DS0000006769.V359305.R01.S.doc Version 5.2 Page 20 and a hoist. On Grandville unit one of the toilets in the bathroom was stuck down with tape. One staff member said this was because staff use it and the staff toilet was on another floor. This was confirmed by the manager. It would seem advantageous to have as many toilets available as possible. On Knoll unit access to a toilet was obscured by a wheelchair being stored in the area. It is apparent that the provider needs to increase storage space within the home to minimise the risk of residents and staff being injured. One of the taps to the bath was not working and staff stated this had been in this condition for some time. The present site of toilet roll holders in relation to the toilets means that some people may not be able to reach them without overstretching and it is recommended that this issue be reviewed to reduce the risk of people falling. Clinical waste was stored in lidded bins and hand-washing facilities were good. Staff stated they are good supplies of protective clothing, antiseptic hand wash etc. Bacterial gel was also provided and located in areas accessible to staff and visitors. The training coordinator was undertaking a hand-washing audit to ensure that staff wash their hands properly. The Sidcup Nursing And Residential Centre DS0000006769.V359305.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home would benefit from a review of staffing levels to ensure there are a sufficient number of staff employed to meet their needs. Sound recruitment procedures help to protect people living in the home from harm. Residents benefit from receiving care from staff that are suitably qualified. EVIDENCE: Issues in relation to staffing arose on all three floors. Hatherley unit would benefit from another qualified person to help administer medication to reduce the amount of time this task takes (see standard nine). Staff on Grandville and Knoll unit stated that staffing levels were reduced if the occupancy of the unit was reduced. For example on the Grandville unit the week before we visited there were only two carers and one nurse on duty at night because there were three empty beds. Staff said that when staffing levels were reduced during the evening they found it difficult to manage because the trained staff were giving out medicines and supervising supper. This left four carers to feed 16 residents. Knoll unit accommodates people assessed as requiring residential care. The staffing ratio has remained the same for the past eight years and does not reflect the current dependency level of the people being accommodated. At the time we visited nine people were wheelchair dependent, four people required The Sidcup Nursing And Residential Centre DS0000006769.V359305.R01.S.doc Version 5.2 Page 22 the assistance of two members of staff for moving and handling and other aspects of personal care. Staff stated the unit needed a minimum of five care staff particularly in the morning, however there were generally only four which leaves one person to administer medication, one to prepare and take breakfast to people in their bedrooms and two trying to assist people with their morning personal care. Only two people said always when asked in the survey are the staff available when you need them. Other comments made were staff are always rushing around. Some people on these units also said they had to wait a long time for a response when activating the emergency call system one person said 20 to 30 minutes. The provider is required to undertake an assessment of need in relation to the people accommodated and provide appropriate staffing levels to meet their needs. Staff files were examined in relation to two members of staff employed in the last 12 months. Files included all of the appropriate and relevant documents, there was evidence that CRB/POVA checks had been undertaken, two references, application form, record of interview, recent photo, proof of identity, job description, signed contract and information about the persons health. Records seen indicate 52 of staff had a vocational qualification in care at level two or above. Thirteen staff were registered to undertake this programme in 2008. The training Coordinator has recently increased her hours from 30 to 36 per week. Training records were well- organised and easy to track. BUPA complete an annual training matrix which is compulsory and arranged by the training coordinator. Training is facilitated by senior staff or the training coordinator, some provided by external people and some by the use of training videos. Staff complete a small exercise or test after some of the sessions. The training coordinator receives regular training updates and has access to a training manual. Staff receive induction training, which usually lasted between 2-3 days depending on the persons experience etc, but can be extended if necessary. Induction covers key topics including fire safety, use of bedrails, moving and handling, abuse, health and safety and food hygiene training and the employee spends some time observing care practices. The employee has to complete a learning portfolio within 12 weeks of starting work in the home. The portfolio covers the common induction standards. There are different workbooks for nursing, care and ancillary staff. The Sidcup Nursing And Residential Centre DS0000006769.V359305.R01.S.doc Version 5.2 Page 23 A requirement was made at the time of the last inspection regarding the need for staff responsible for supervision of staff to have appropriate training. The training coordinator stated that training in relation to supervision of staff was being cascaded down to all senior members of staff responsible for undertaking this task. The Sidcup Nursing And Residential Centre DS0000006769.V359305.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a home that is well run and managed. Residents living in the home can be assured that BUPA will monitor the care and service provided. All accident reports must be completed to protect staff and residents in the home. EVIDENCE: The current centre manager is suitably qualified and experienced to run the service. Staff said senior staff and the manager were approachable and helpful. BUPA has comprehensive systems in place to monitor the care and services provided and ascertain the views of people living in the home and other relevant stakeholders on a regular basis. The Sidcup Nursing And Residential Centre DS0000006769.V359305.R01.S.doc Version 5.2 Page 25 The home provides assistance to residents to manage personal allowances. All money is held in the providers interest-bearing account. Relatives, solicitors and other relevant parties provide personal allowance money on behalf of individual residents. Computer records are kept for money received and spent and receipts obtained on residents’ behalf. Financial records were checked for two residents and found to be correct. BUPA also undertake regular audits of the system. Records seen indicate there are systems in place to carry out routine in-house maintenance checks on hoists, slings, bedrails, wheelchairs and monthly checks on hot water temperatures. The fire alarm is tested weekly and the system regularly serviced. The last fire drill was held recently and included night staff. The record included comments on the response but had not been signed by the 9 staff attending. Fire safety training was provided for 37 staff on 24/10/07 and 26 staff on 7/11/07. Records seen indicate safety checks to portable electrical appliances are undertaken on a regular basis. There was evidence that baths and hoists also receive regular safety checks. Staff maintain a record of hot water temperature when a resident is bathed. Moving and handling guidelines were visible in all resident’s bedrooms seen. Trolleys used by cleaners for transporting cleaning materials include separate lockable compartments for storing hazardous substances. A cleaner spoken with said she had received COSHH training and had access to COSHH assessments and data sheets. A sample of records were examined in relation to accidents. The daily care records for one person indicated they had fallen twice on one day however staff could only find an accident report pertaining to one of these incidents. In another instance it was not possible for staff to locate the accident report for a person whose daily record indicated they had sustained a fracture. A third accident form seen was properly completed and included adequate information. The form also stated what action staff had taken to prevent further falls or injuries and was checked and signed by the manager. All accident reports must be completed to protect staff and residents in the home. The Sidcup Nursing And Residential Centre DS0000006769.V359305.R01.S.doc Version 5.2 Page 26 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 In CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X n/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 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 3 X 2 The Sidcup Nursing And Residential Centre DS0000006769.V359305.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The registered person must ensure care plans include details as to what action staff take to manage residents with aggressive behaviour. 31/05/07 not met. The registered person must ensure medicines are safely managed, stored and recorded. Not met 31/05/07 Ensure adequate time is allowed between administrations of medicines. Administration records must show that all prescribed medicines are administered including topical applications and nutrition supplements. Two staff must sign hand written entries they make on administration charts and the details must reflect the information on the pharmacy label. Accurate records must be kept for all records brought into the home so that an audit trail can be completed including medicines for residents admitted for respite care and homely DS0000006769.V359305.R01.S.doc Timescale for action 30/04/08 2 OP9 13 30/04/08 The Sidcup Nursing And Residential Centre Version 5.2 Page 28 3 OP38 13 4 OP8 12 5 OP16 22 6 OP18 13 7 OP19 23 8 OP27 18 remedy medicines. Staff must ensure that residents received prescribed medicines and ensure adequate supplies are in stock. Staff must not transfer medicines from one dispensed container to another. An up to date and detailed homely remedy list of medicines must be signed by the GP and must not include topical applications. The registered person must as far as possible eliminate unnecessary risks to the health and safety of residents in this instance ensure that the risk assessment in relation to lap belts include strategies to reduce the risk of injuries to residents. 31/05/07 not met The registered person must ensure appropriate nutritional screening is undertaken on admission and subsequently on a periodic basis and maintain a record of nutrition, including weight gain or loss and appropriate action taken. The registered person must keep a record of complaints received and the action taken to investigate them. The registered person must ensure that staff receive training in relation to safeguarding adults and follow appropriate procedures The registered person must ensure that sufficient storage space is provided to accommodate equipment required by a staff and residents. The registered person must ensure that there are sufficient numbers of staff employed to meet the assessed needs of the DS0000006769.V359305.R01.S.doc 30/04/08 30/04/08 31/03/08 01/05/08 30/06/08 01/06/08 The Sidcup Nursing And Residential Centre Version 5.2 Page 29 9 OP38 17(2)sch 4 residents accommodated. The registered person must keep a record of any accident that occurs in the home 01/04/08 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 OP9 Good Practice Recommendations Develop a medicine profile for each resident with evidence of regular medicine reviews. Develop protocols for administration of ‘as required’ medicines such as pain relief for residents with poor or no communication skills. Staff responsible for administering medication need to be assessed annually as being competent to do so. Maintain more comprehensive records in relation to activities residents participate in. Meal times should be arranged so residents are not kept sitting long periods of time waiting for meals to be served. Make available for use all toilets within the home. 2 3 4 OP12 OP15 OP19 The Sidcup Nursing And Residential Centre DS0000006769.V359305.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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. 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