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Inspection on 12/05/05 for The Sidcup Nursing And Residential Centre

Also see our care home review for The Sidcup Nursing And Residential Centre for more information

This inspection was carried out on 12th May 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

What the care home does well

Sidcup Nursing and Residential Centre provides a safe and comfortable environment for residents. The building was maintained to a high standard and all areas were kept clean and tidy. Residents can take part in group activities or attend the musical entertainment sessions that occur in the home. Facilities for visitors were good and visiting arrangements were flexible. The well-tended garden provides a peaceful area for residents to sit during the summer months. Residents were able to make choices about where and how they spent their time and were encouraged to contribute to the day- to- day running of the home where possible. The food provided in the home was appetising and nutritious and special diets were catered for.The majority of residents and relatives spoken with during the inspection were satisfied with the care provided. Comments made by residents included "I`ve been in some places but this home should get 10 out of 10", I did not want to come here, I cried and cried, but its very comfortable, clean and nice". Action was taken by staff to ensure that residents were kept clean and comfortable. Some staff members had established good working relationships with residents and their relatives. Staff communicated effectively with residents and kept relatives informed about important matters. The home was well organised and managed. Staff were aware of their roles and responsibilities. Access to community healthcare services was good and a number of professionals such as the General Practitioner, Physiotherapist and Chiropodist visit the home regularly.

What has improved since the last inspection?

Since the last inspection action had been taken to improve staffing levels. All shifts had an adequate number of care and nursing staff and some shifts had additional trained nurses. The stale odour noted during the previous inspection had been resolved and all areas were clean and tidy. New equipment had been purchased to meet the needs of residents who had a physical disability or were frail. Action was in progress to ensure that staff had access to a moving and handling trainer and receive regular moving and handling training updates.

What the care home could do better:

The information in the homes Statement of Purpose and Service User`s Guide about the age of residents that the home can admit is incorrect and must be amended. Care documentation was variable. Some care plans were good whilst others did not include adequate information about some of the resident`s current needs or did not state what action was being taken by staff to address risks. Good systems were in place to ensure that a record was maintained of all medication received into the home or sent for disposal. Some medicines prescribed by a doctor for one person were being administered to other people living in the home. This arrangement is not safe and must stop.A contract for staff supervision had been introduced but supervision was not taking place regularly. A number of residents on the nursing floors were wearing a lap belt. This form of restraint should only be used when there is no other means of ensuring the safety of the resident. The home must formally review all residents who wear lap belts to ensure that the decision to use this equipment is made in the best interest of the resident.

CARE HOMES FOR OLDER PEOPLE The Sidcup Nursing And Residential Centre 2 - 8 Hatherley Road Sidcup Kent DA14 4BG Lead Inspector Maria Kinson Unannounced 12 May 2005 11.15am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Sidcup Nursing And Residential Centre G51 G01 S6769 Sidcup NR Centre V211938 120505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Sidcup Nursing And Residential Centre Address 2-8 Hatherley Rd Sidcup Kent DA14 4BG 020 8300 7711 020 8300 7799 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) ANS Homes Limited Mrs Jane Brock Care Home 100 Category(ies) of Old age, not falling within any other category registration, with number (90) of places Physical disability (10) The Sidcup Nursing And Residential Centre G51 G01 S6769 Sidcup NR Centre V211938 120505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 71 beds for the general nursing care for people 60 years to include 10 beds for the physically disabled aged between 50 – 59 years 29 beds for the residential care of the elderly. Date of last inspection 07.03.05 Brief Description of the Service: The Sidcup Nursing and Residential Centre is owned and operated by ANS Homes. It was purpose built as a nursing home and the ground and first floors were registered in 1997 to provide nursing care. In 1998, the second floor, which had not been in operation, was registered for residential care. The ground and first floors are for the general nursing care of 71 service users. The second floor provides residential care for 29 older people. All the bedrooms in the home have en-suite 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 G51 G01 S6769 Sidcup NR Centre V211938 120505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out an unannounced inspection at Sidcup Nursing and Residential Centre on Thursday 12th May 2005 between 11.15am and 5pm. The inspectors spent the majority of their time on the first and second floor units, Knoll and Granville. Care, medication and complaints records were examined and copies of the current staffing roster were obtained. The inspectors joined some of the residents for lunch on Knoll and Granville, observed medication being administered on Knoll and observed staff communicating with residents, assisting residents with meals and drinks and repositioning residents who had difficulty moving. Six members of staff, nine residents and five visitors were spoken with during the inspection and comment cards were distributed to residents, relatives, general practitioners, health and social care professionals and care managers who had contact with the home. Eleven questionnaires were returned to the commission. One additional inspection had taken place in the home in March 2005 to investigate three complaints made to the commission about staffing levels and odour on the nursing units. The concerns raised were upheld. The Registered Person was required to ensure that the minimum numbers and grade of staff, as outlined in the staffing notice issued by Bexley and Greenwich Health authority on 20.08.99, is adhered to at all times and that the home is kept free from offensive odours. These requirements were assessed during this inspection and had been met. What the service does well: Sidcup Nursing and Residential Centre provides a safe and comfortable environment for residents. The building was maintained to a high standard and all areas were kept clean and tidy. Residents can take part in group activities or attend the musical entertainment sessions that occur in the home. Facilities for visitors were good and visiting arrangements were flexible. The well-tended garden provides a peaceful area for residents to sit during the summer months. Residents were able to make choices about where and how they spent their time and were encouraged to contribute to the day- to- day running of the home where possible. The food provided in the home was appetising and nutritious and special diets were catered for. The Sidcup Nursing And Residential Centre G51 G01 S6769 Sidcup NR Centre V211938 120505 Stage 4.doc Version 1.30 Page 6 The majority of residents and relatives spoken with during the inspection were satisfied with the care provided. Comments made by residents included “I’ve been in some places but this home should get 10 out of 10”, I did not want to come here, I cried and cried, but its very comfortable, clean and nice”. Action was taken by staff to ensure that residents were kept clean and comfortable. Some staff members had established good working relationships with residents and their relatives. Staff communicated effectively with residents and kept relatives informed about important matters. The home was well organised and managed. Staff were aware of their roles and responsibilities. Access to community healthcare services was good and a number of professionals such as the General Practitioner, Physiotherapist and Chiropodist visit the home regularly. What has improved since the last inspection? What they could do better: The information in the homes Statement of Purpose and Service Users Guide about the age of residents that the home can admit is incorrect and must be amended. Care documentation was variable. Some care plans were good whilst others did not include adequate information about some of the resident’s current needs or did not state what action was being taken by staff to address risks. Good systems were in place to ensure that a record was maintained of all medication received into the home or sent for disposal. Some medicines prescribed by a doctor for one person were being administered to other people living in the home. This arrangement is not safe and must stop. The Sidcup Nursing And Residential Centre G51 G01 S6769 Sidcup NR Centre V211938 120505 Stage 4.doc Version 1.30 Page 7 A contract for staff supervision had been introduced but supervision was not taking place regularly. A number of residents on the nursing floors were wearing a lap belt. This form of restraint should only be used when there is no other means of ensuring the safety of the resident. The home must formally review all residents who wear lap belts to ensure that the decision to use this equipment is made in the best interest of the resident. 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 Sidcup Nursing And Residential Centre G51 G01 S6769 Sidcup NR Centre V211938 120505 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Sidcup Nursing And Residential Centre G51 G01 S6769 Sidcup NR Centre V211938 120505 Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 3 (Standard 6 does not apply to this home) Information in the form of a Statement of Purpose and Service Users Guide was provided for prospective residents. Whilst both documents assist residents to make an informed decision about whether they wish to move into the home, the information about the age of residents that the home can admit is misleading. Staff assessed prospective residents prior to admission to ensure that the home was able to meet the individual’s health and welfare needs. EVIDENCE: The home has a comprehensive Statement of Purpose and Service Users Guide but the information in these documents about the age range of residents that can be admitted to the home was incorrect. The Registered Person must amend the Statement of Purpose and Service Users Guide and forward a copy of the revised documents to the commission. See requirement 1. Senior staff assess prospective residents needs prior to admission. Comprehensive notes were made about the assessor’s findings and instructions The Sidcup Nursing And Residential Centre G51 G01 S6769 Sidcup NR Centre V211938 120505 Stage 4.doc Version 1.30 Page 10 for staff about specific care or attention that was required to meet the individual’s needs. The Sidcup Nursing And Residential Centre G51 G01 S6769 Sidcup NR Centre V211938 120505 Stage 4.doc Version 1.30 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 Some of the documentation did not provide adequate evidence that all of the residents care needs were being met. Some medicines prescribed for one individual were being administered to other residents. This practice could compromise resident’s safety. Access to healthcare services was good enabling residents that are unwell to be assessed and treated promptly. EVIDENCE: The files for five residents were examined on Granville and Knoll. All of the residents had a variety of assessments including moving and handling, risk of developing pressure sores and nutritional assessments. Staff had used this information to develop a plan of care for each individual. Some of the care plans did not reflect the current needs of the resident, were incomplete in parts or were not up to date. For instance on the nursing unit there was no indication in the care plan that an individual had MRSA and on the nursing and residential units residents were assessed as being at high risk of developing pressure sores but did not have a plan in place to reduce the risks. Care plans were reviewed regularly but were not always signed by the resident or staff The Sidcup Nursing And Residential Centre G51 G01 S6769 Sidcup NR Centre V211938 120505 Stage 4.doc Version 1.30 Page 12 member. There were no risk assessments in some of the files for residents who were using bedrails. See requirement 2. Wound care documentation was mostly good. Equipment to prevent cross infection was available in the relevant residents rooms and staff were given a personal supply of gloves. Some of the residents said that their physical health, weight and mobility had improved since moving into the home. Residents who could use the seated weighing scales were weighed regularly. The records viewed showed regular GP and other health professional visits. The feedback from three health care professionals who visit the home regularly was good but one respondent did express concerns regarding the “regular use of restraining straps” (lap belts). See standard 18. Residents, relatives and health care professionals were satisfied with the overall standard of care provided in the home. Staff were observed administering medication during the lunch period on Knoll. Staff observed residents taking their medication and answered residents questions or concerns about medication promptly. Some residents administered their own medication. Staff carried out a risk assessment prior to allowing residents to self medicate and carried out regular checks to ensure that medication was being taken regularly. Residents who were administering their own medication were advised to keep medication in the lockable bedside cabinet. It was noted during the inspection that the supply of some medicines such as Lactulose and Paracetemol, which were prescribed for named individuals, were being used for other residents who were prescribed the same medication. The Medicines Act clearly states that medicines must only be administered to the person for whom they have been prescribed, labelled and supplied. This practice must stop. See requirement 3. Records of receipt and disposal of medication was good but staff must ensure that if they discover additional medication after admission this is also recorded. The home has a homely remedies policy, which was agreed and signed by the GP in 2000. This agreement should be reviewed and updated. See recommendation 1. During this inspection a review of the use of night sedation was being carried out in the home. Only three residents were prescribed night sedation. The effort made by staff and other healthcare professionals to avoid the use of hypnotic medication is commended. Staff on all of the units took action to maintain resident’s privacy and dignity. Since the last inspection the commission had received a letter from a Care Manager who had arranged an emergency admission to the home. The Care Manager advised the commission that she was extremely impressed with the care and attention given to her client and for the sensitive approach taken by staff on the residential unit. The Sidcup Nursing And Residential Centre G51 G01 S6769 Sidcup NR Centre V211938 120505 Stage 4.doc Version 1.30 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 standard(s) 12, 13, 14 and 15 The residents in this home have access to regular activities and entertainment, receive a good variety and choice of food and are free to choose how and where they spend their time. All of these factors contribute to a sense of wellbeing for residents. EVIDENCE: The home employs an Activities Co-ordinator who facilitates a regular programme of activities on each floor and books musicians and singers to entertain residents in the home. Some shopping trips were taking place to Sidcup High Street but were limited as the Activities Coordinator was only able to take one resident at a time due to difficulties with mobility. Residents were free to choose whether they wanted to take part in activities and were not pressurised to attend entertainment sessions. Some of the residents said they had particularly enjoyed the sessions to commemorate VE day. On the residential unit staff encouraged residents to become involved with the running of the unit by taking on small jobs such as feeding the fish and helping other residents to complete the menu cards. Visiting hours were flexible to suit families and relatives that work full time. Refreshments were provided for visitors and fresh sandwiches can be purchased for a small charge. Written and verbal feedback was obtained The Sidcup Nursing And Residential Centre G51 G01 S6769 Sidcup NR Centre V211938 120505 Stage 4.doc Version 1.30 Page 14 visitors during and following the inspection. The majority of visitors were satisfied with the overall standard of care provided in home but some concerns were expressed about staffing levels and the care provided on night duty (see standard 27). Routines were flexible and residents were encouraged to make choices and decisions. One resident told the inspector “I am able to get up and go to bed when I want, I choose my own clothes, there are no restrictions”. Staff encouraged residents to attend the musical entertainment that was taking place on the nursing floor, residents that indicated that they did not want to attend remained in their rooms or the communal lounges. The inspectors joined some of the residents for lunch on Knoll and Granville. Residents were able to choose from the menu and special dietary needs were catered for. One of the residents has very complex dietary needs and numerous allergies. This resident told the inspector that the Manager and Cook had spent time discussing his dietary needs prior to and after admission. The resident said that staff had gone out of their way to ensure that he was given a appropriate diet and he was now getting a much more varied diet than he had experienced elsewhere. Food was presented nicely and looked and tasted good. A good variety and choice of food was included on the menu and residents were able to request alternative dishes such as poached eggs if they did not like the food listed. Tables were laid out in a welcoming manner with napkins, condiments and cold drinks and were arranged in small units to allow residents to socialise. The majority of the residents spoken to said that the food was good and portions were generous. One resident on the nursing unit appeared to have difficulty eating due to ill-fitting teeth. This issue was not noted in the residents care plan. See requirement 2. Staff provided assistance and encouragement as necessary and specialist equipment to assist residents to eat and drink independently. The Sidcup Nursing And Residential Centre G51 G01 S6769 Sidcup NR Centre V211938 120505 Stage 4.doc Version 1.30 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 standard(s) 16, 17 and 18. The home has a comprehensive complaints and adult protection procedure in place for responding to complaints or allegations of abuse. The use of lap belts in the home must be reviewed to ensure that this equipment is only used in exceptional circumstances and when there are no other means of securing a residents safety. EVIDENCE: One additional visit had been carried out since the last statutory inspection to investigate three anonymous complaints. The complaints were made by telephone to the Duty and Lead Inspector and were all related to concerns about staffing levels on the nursing units. Two of the callers also raised concerns about odour. The inspectors found that there had been difficulties at times covering staff sickness and annual leave and as a result there had been inadequate staff on some shifts. There was a stale urine odour in the corridor on Granville near the sluice, shower room and bedrooms 12a and 22. A letter was sent to the Registered Person following the visit and two requirements were set. The Registered Person responded promptly outlining the action that they were taking to meet the requirements. Both requirements were assessed during this inspection and had been met. The Sidcup Nursing And Residential Centre G51 G01 S6769 Sidcup NR Centre V211938 120505 Stage 4.doc Version 1.30 Page 16 The homes complaints procedure was displayed in the reception area and records of complaints were maintained in the manager’s office. Three complaints had been received since the last statutory inspection. The concerns raised were about care practices, medication and communication. All of the complaints were acknowledged and responded to promptly. Following the last statutory inspection it was recommended that the Registered Person review all residents who use lap belts to ensure that the use of this equipment was absolutely necessary. Reviews had taken place but did not involve the residents Care Manager. A significant number of residents on the nursing units were still using a lap belt. One healthcare professional that visits the home raised concerns about the use of this equipment (see standard 7-11, page 13). To ensure that lap belts are only used when there is no other means of ensuring the residents safety the Registered Manager must arrange for all residents that use a lap belt to be formally reviewed. Residents, relatives and other professionals involved in the residents care should be asked to contribute to this review. Copies of the assessments must be forwarded to the commission by 01.01.06. See requirement 4. A copy of recent guidance issued to inspectors about the use of lap belts was forwarded to the Registered Manager. The home had policies and procedures for managing allegations of abuse and a copy of the local authority guidance. Staff were aware that allegations of abuse should be reported to senior staff immediately. The Activity Co-ordinator was responsible for providing assistance and help to residents who wanted to vote during national or local elections. This was mainly completed through the postal voting system. The majority of residents spoken with had little interest in voting but confirmed that they had been offered the opportunity to vote. The Sidcup Nursing And Residential Centre G51 G01 S6769 Sidcup NR Centre V211938 120505 Stage 4.doc Version 1.30 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 22, 23 and 26 All parts of the home and grounds were maintained to a high standard. This provides a clean, attractive and safe environment for residents. EVIDENCE: The home and grounds were maintained to a high standard. All of the communal areas had high quality furniture and fittings and space to socialise or sit quietly. The garden was well maintained and was highlighted by a number of residents as being a popular spot to observe wildlife. Some of the resident’s bedrooms included furniture and personal items from their homes, which made the rooms appear more welcoming and homely. Plans were being made to redecorate and refurbish the residential unit and fit air conditioning in the kitchen in 2005. The Sidcup Nursing And Residential Centre G51 G01 S6769 Sidcup NR Centre V211938 120505 Stage 4.doc Version 1.30 Page 18 Since the last inspection the home had purchased twenty new height adjustable beds and fifteen sets of extra height bedrails. Plans were being made to purchase further supplies of this equipment in 2005/6. All parts of the home were clean, tidy and odour free. Soap and disposable hand towels were available in relevant areas. The Sidcup Nursing And Residential Centre G51 G01 S6769 Sidcup NR Centre V211938 120505 Stage 4.doc Version 1.30 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 Since the last inspection staffing levels had improved and the work to recruit a full establishment of staff continues. This work is likely to lead to improved continuity of care for residents. EVIDENCE: The off duty roster for the week commencing 24/4/05 showed appropriate numbers and skill mix of staff. On some shifts the number of trained staff exceeded the minimum numbers outlined in the homes staffing notice. The majority of residents and relatives spoken with were very complimentary about the staff and told the inspectors that staff were kind, caring and patient. However some residents and relatives did express concerns about staffing levels and the care received at night. The inspectors were not able to obtain specific information during this visit. In view of the concern about care practices at night the Registered Manager should attempt to obtain more detailed information from residents about this issue. See recommendation 2. Interactions between staff and residents on the day of the inspection were very good with staff seen reassuring residents who were anxious and using effective strategies to communicate. One of the residents who was a little disorientated became quite verbally aggressive during the lunch period, the staff member administering medication acknowledged the residents concerns and reassured her that she would personally put things right. This non-challenging approach The Sidcup Nursing And Residential Centre G51 G01 S6769 Sidcup NR Centre V211938 120505 Stage 4.doc Version 1.30 Page 20 made the resident feel that her concerns were being treated seriously by staff and quickly diffused her anger. The home recruits new staff on a continuous basis. Staff interviews were held in the home each month and new staff were appointed where possible. The number of applicants that could not provide adequate documentation or do not turn up for interviews was very high. An advertisement had been placed in the national nursing press for a deputy manager but little response was received. The current deputy manager will remain in post until a successor is appointed. The previous requirement to ensure that adequate documentation was obtained for new staff was not assessed during this inspection due to time constraints. See requirement 5. The inspector would like to make a formal apology to the manager and staff for a previous requirement relating to the recruitment of new staff (see unannounced inspection 24/11/04) requirement two, part two. The regulation relating to this requirement had been misinterpreted by the inspector and was incorrectly recorded as non- compliance with The Care Homes Regulations 2001. A new training coordinator had been appointed and was due to commence work in the home in May 2005. The deputy manager had agreed to attend a moving and handling trainers course in May 2005. Once this course is complete staff will receive a moving and handling training update. See requirement 6. The Sidcup Nursing And Residential Centre G51 G01 S6769 Sidcup NR Centre V211938 120505 Stage 4.doc Version 1.30 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 36 This home is managed by an experienced and competent manager who is committed to maintaining good standards of care. Further work is required to ensure that appropriate support mechanisms are in place for staff. EVIDENCE: The management arrangements in the home were stable. The Manager of the home was assessed by the Commission in 2002 and was found to have relevant qualifications and experience to manage a care home for older people. The inspectors were told that a supervision contract was now in place. The staff that the inspectors spoke with confirmed that they were able to discuss issues of concern with their line manager at anytime but denied that they met The Sidcup Nursing And Residential Centre G51 G01 S6769 Sidcup NR Centre V211938 120505 Stage 4.doc Version 1.30 Page 22 a named supervisor regularly to discuss practice and training issues. See recommendation 3. Good records were maintained of accidents that occurred in the home and the commission were notified in writing about significant events. Night staff were responsible for cleaning wheelchairs and the homes maintenance employee undertook minor repairs. A regular maintenance programme should be introduced to ensure that all wheelchairs are serviced regularly. The Sidcup Nursing And Residential Centre G51 G01 S6769 Sidcup NR Centre V211938 120505 Stage 4.doc Version 1.30 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 x 3 3 x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 2 3 x x x x 2 x 3 The Sidcup Nursing And Residential Centre G51 G01 S6769 Sidcup NR Centre V211938 120505 Stage 4.doc Version 1.30 Page 24 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 17 Requirement The Registered Person must ensure that the Statement of Purpose and Service Users Guide provides accurate information about the age range of service users that can be admitted to the home. (Previous timescale of 01.04.05 not met) The Registered Person must ensure that care plans identify potential risks and outline the action that staff should take to meet individuals health and welfare needs. The Registered Person must ensure that staff do not administer medication prescribed by a doctor for one person, to other people living in the home. The Registered Person must undertake a formal review of all residents using lap belts. The review must involve other professionals that have an interest in the residents care and must establish if lap belts are the only practicable means of of securing the welfare of the resident. A copy of the review papers must be forwarded to the commission by 01.01.06. Timescale for action 01 September 2005 2. 7 13 & 15 01 August 2005 3. 9 13 14 July 2005 4. 18 13(7) 01 January 2006 The Sidcup Nursing And Residential Centre G51 G01 S6769 Sidcup NR Centre V211938 120505 Stage 4.doc Version 1.30 Page 25 5. 29 19 6. 30 13 The Registered Person must not allow a person to work at the care home unless all of the information and documents listed in paragraph 1 to 9 of Schedule 2 have been obtained. (This requirement was set during a previous inspection but was not assessed during this visit) The Registered Person must ensure that all staff receive a moving and handling training update annually. (Previous timescale of 01.05.05 not met) 01 March 2005 01 September 2005 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. 4. Refer to Standard 9 27 36 Good Practice Recommendations The Registered Person should review and update the homely remedies list in conjunction with the GP. The Registered Manager should obtain regular feedback from residents about the care provided in the home at night. The Registered Person should ensure that care staff receive formal supervision at least six times a year. The Sidcup Nursing And Residential Centre G51 G01 S6769 Sidcup NR Centre V211938 120505 Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection River House 1 Maidstone Road Sidcup, Kent DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Sidcup Nursing And Residential Centre G51 G01 S6769 Sidcup NR Centre V211938 120505 Stage 4.doc Version 1.30 Page 27 - 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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