Inspection on 23/05/07 for Upminster Nursing Home

This inspection was carried out on 23rd May 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

Upminster Nursing Home 11/08/06

Upminster Nursing Home 08/05/06

Upminster Nursing Home 05/12/05

Upminster Nursing Home 31/05/05

Upminster Nursing Home 16/09/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Upminster Nursing Home Clay Tye Road Upminster Essex RM14 3PL Lead Inspector Ms Gwen Lording Unannounced Inspection 23rd May 2007 09:10 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 Upminster Nursing Home DS0000062200.V339022.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. Upminster Nursing Home DS0000062200.V339022.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Upminster Nursing Home Address Clay Tye Road Upminster Essex RM14 3PL 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) 01708 220201 01708 641420 Havering Care Homes Limited Manager not currently registered. Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (37), Physical disability over 65 years of age (1) of places Upminster Nursing Home DS0000062200.V339022.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th November 2006 Brief Description of the Service: Upminster Nursing Home is a purpose built care home owned by Havering Care Homes Limited. The home is situated in a rural area between Upminster and North Ockendon. The home can accommodate up to 38 older people and is registered to provide nursing care. The accommodation is on three floors, the lower ground floor, the ground floor and the first floor. There are 34 single bedrooms and 2 shared bedrooms. All rooms have an en-suite with a toilet and wash hand basin. The home has wheelchair access and a passenger lift is provided. On the day of the inspection the range of fees for the home was between £520.00 and £700.00 per week. A copy of the Statement of Purpose and Service User Guide to the home and a copy of the most recent inspection report are located in the reception area or made available on request. Upminster Nursing Home DS0000062200.V339022.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 key inspection, which started at 9am and took place over six and a half hours. The inspection was undertaken by two inspectors, namely the lead inspector Gwen Lording and Julie Legg. The manager and deputy manager were available throughout the visit to aid the inspection process. The manager has recently been appointed has been in post since the end of March this year. Her application to be registered as the manager is currently being processed by the Commission. Discussions took place with the manager and also recently appointed deputy manager; several members of nursing and care staff; kitchen and laundry staff; the activities co-ordinator; and the administrator. The inspectors spoke to a number of residents and relatives; and where possible residents were asked to give their views on the service and their experience of living in the home. Nursing and care staff were asked about the care that residents receive, and were also observed carrying out their duties. A tour of the premises, including the laundry and main kitchen was undertaken and all areas were clean and tidy with no offensive odours. The files of several residents were case tracked, together with the examination of other staff and home records. This included medication administration, activity programmes, staff rotas and training records; maintenance records, complaints and staff recruitment procedures and files. Information was also taken from a preinspection questionnaire, which was completed by the manager and returned to the Commission. As part of the inspection process the views of several community health care professionals who provide a service to the home were sought and are commented on in this report. A visit was made to the home in November 2006 following concerns around the management of medication. An Immediate Requirement Notice was issued for the registered persons to ensure that that there was a robust system in place for the management of medicines. An additional inspection was also undertaken by a specialist pharmacy inspector. The organisation complied in full with requirements made at the time of these additional visits. The concerns were investigated through the London Borough of Havering’s, Safeguarding Adults protocol. The organisation worked co-operatively with the Commission and local authority to address these concerns. The people living in the home and the manager were asked how they wished to be referred to during the inspection and in the report. They expressed a wish to be referred to as ‘residents’. Upminster Nursing Home DS0000062200.V339022.R01.S.doc Version 5.2 Page 6 At the end of the visit the inspectors were able to provide feedback to the manager and the deputy manager. The inspectors would like to thank the residents and staff for their input during the inspection. What the service does well: What has improved since the last inspection? A total of sixteen requirements were made at the last key inspection and these have been met. A new manager has been in post since March this year and her application to be registered as the manager is currently being progressed by the Commission’s Central Registration Team. The home has also appointed a deputy manager. The manager has a clear understanding of what improvements are needed and the key areas in which the home needs to further develop. She is very resident Upminster Nursing Home DS0000062200.V339022.R01.S.doc Version 5.2 Page 7 focused and with the support of the deputy manager she is committed to build a strong staff team and work continuously to improve the service, in partnership with the families of residents and professionals. 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. Upminster Nursing Home DS0000062200.V339022.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 Upminster Nursing Home DS0000062200.V339022.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 2, 3, 4, & 5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Comprehensive pre-admission assessments are being undertaken for all residents prior to them moving into the home. Care plans are drawn up from the information in this assessment, ensuring that the needs of the residents are identified, understood and met. Prospective residents and their relatives/ representatives have the opportunity to visit the home prior to making any decision to move in. This enables them to assess the facilities and suitability of the home and ask any questions about life in the home. The home does not offer intermediate care. Upminster Nursing Home DS0000062200.V339022.R01.S.doc Version 5.2 Page 10 EVIDENCE: Individual records are kept for each resident and a number of files were examined. The manager has introduced a new pro forma assessment form and this was seen to be very comprehensive. The completed pre-admission assessment of a recently admitted resident was examined. This had detailed assessment information recorded and the information had been used to continue assessment following admission to the home, and develop a written care plan. Currently the manager or deputy manager undertakes these assessments. The inspectors were satisfied that that a full assessment of need is undertaken prior to a resident moving into the home, and that the manager would not admit a new resident unless she was sure that the assessed needs of the individual could be met. The records showed that residents and their relatives/ representatives are involved in the assessment process. Where appropriate, information provided by the placing authority was also included. Residents and relatives are encouraged to visit the home prior to making any decision to move in. The inspector spoke to four relatives, all of whom stated that their parents or partners were unable to visit the home prior to their admission due to their frailty. However, all of the relatives spoken to had taken the opportunity to visit the home prior to the residents’ admission. Three stated that they had visited a number of other homes before choosing Upminster Nursing Home. One relative stated: “I liked the atmosphere, as soon as I walked in. The staff were very helpful and let me look around and ask questions”. All residents receive a contract/ statement of terms and conditions, which clearly sets out the fees and includes information about any individual nursing or resident contributions. The manager was provided with a copy of the Commission’s ‘Policy and Guidance on Provision of Fees Information by Care Homes’ This sets out what information care home providers need to include in the Service User Guide regarding fees and terms and conditions, and is in a format that is easy to understand. Upminster Nursing Home DS0000062200.V339022.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, 10 & 11. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents’ health, personal and social care needs are set out in individual care plans and generally provide staff with the information they need to satisfactorily identify and meet residents’ needs There are clear medication policies and procedures to follow, so as to ensure that residents are safeguarded with regard to medication. Medication audits are undertaken by the manager on a regular basis. EVIDENCE: The style of care plan in current use is a standardised format, which is then individualised to address the specific elements of an individuals care. However, there is some inconsistency in the completion and standard of care planning. The manager has developed new care planning documentation which will make care plans more ‘person centred’. The implementation of these care plans will Upminster Nursing Home DS0000062200.V339022.R01.S.doc Version 5.2 Page 12 be introduced in stages throughout the home, with staff undertaking appropriate training in its use. The inspectors were able to view the pro-forma documentation and the care plan of a recently admitted resident which had been completed by the manager. They have the potential to be used as working tools that staff can understand and work to which is clearly to the benefit of residents. Training will also include the development of life histories with the involvement of residents and their family/ friends. Individual care plans were available for each resident and a total of six residents were case tracked and their care plans and related documentation inspected. Care plans were found to be generally detailed and covered health, personal and social care needs. Some care plans evidenced specific regard to cultural and religious needs and how these needs impacted on the type of care provided and the anticipated outcomes for the individual. For example the care plan of one resident specified his cultural needs in respect of care to his skin and hair. Whilst such needs had not been clearly recorded in all of the care plans examined, staff were able to give a good verbal account and understanding of individuals needs. For example staff told the inspector that it was important for one resident to always have their Rosary beads close to hand. There was evidence that care plans were being reviewed at least monthly and updated to reflect changing needs. As far as possible, residents’ and/ or their relatives are involved in the drawing up of their care plan. The documentation/ health records relating to wound management; management of insulin dependant diabetes; catheter care and a recently admitted resident were examined. The records for these residents were found to be generally detailed. However, the care plan for the management of a resident’s diabetes was limited and must be updated accordingly. All residents appeared clean, well groomed, appropriately dressed and spectacles and dentures were clean. One resident who was being nursed in bed and was ‘nil by mouth’ was receiving regular mouth care throughout the visit. Risk assessments are being routinely undertaken on admission around nutrition, manual handling, continence, risk of falls and pressure sore prevention; and are being reviewed on a regular basis. Residents were being weighed on admission and then generally on a monthly basis with fluctuations in weight being monitored and appropriate action being taken where necessary. Files evidenced involvement from health care professionals including, tissue viability nurse specialist, dietician, diabetic nurse specialist; physiotherapist and dental, optical and chiropody services. The tissue viability nurse had visited the home on the 2nd May 07 to review the care for those residents who had pressure sores. She had advised the use of a different type of pressure relieving mattress for one resident and this had been changed in accordance with her advice. Upminster Nursing Home DS0000062200.V339022.R01.S.doc Version 5.2 Page 13 Monitoring charts such as fluid intake/ output; turning regimes and blood sugar monitoring, were up to date and being adequately maintained. Care plans contained some information on ‘End of Life’ wishes and the importance of developing these further was discussed with the manager, during the inspection. From discussions with staff it was apparent that staff dealt with a person’s dying and death in a sensitive and understanding manner, both for the individual and relatives/ friends. Information was given to the manager about the End of Life Care Programme currently being undertaken in North East London and the relevant contact details of the programme manager. Staff talked about and were observed to treat residents in a respectful and sensitive manner. They understood the need to promote dignity through practices such as the way they addressed residents and were observed knocking on bedroom and bathroom doors before entering. A visit was made to the home in November 2006 following concerns around the management of medication. An Immediate Requirement Notice was issued for the registered persons to ensure that that there was a robust system in place for the management of medicines. An additional inspection was also undertaken by a specialist pharmacy inspector. The organisation complied in full with requirements made at the time of these additional visits. An audit was undertaken for the handling and recording of medicines within the home and a sample of Medication Administration Record (MAR) charts were examined. There was a significant improvement in this area. Discussions with staff and the review of medication records show that staff are following policies and procedures, so as to ensure that residents are safeguarded with regard to medication. Medication audits are undertaken on a regular basis and the pharmacy, which provides a service to the home is scheduled to provide medication training to staff later in June. The inspectors spoke to a number of residents and visiting relatives who were asked about the care in the home. They all said that staff were respectful and thoughtful, particularly when attending to personal care. One relative stated: “I’m very happy with the care staff, they treat my relative really well,” another relative said: “Staff respond to the buzzer and are very respectful towards Mum”. Residents spoken to said: “I am happy here, the staff are lovely, nothing is too much trouble”. Another commented: “The staff are really nice (A) is a lovely girl”. Upminster Nursing Home DS0000062200.V339022.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 & 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The lifestyle within the home matches the expectations and preferences of residents and meets individual’s social, cultural, religious and recreational interests and needs. There is a general programme of activities available however; consideration needs to be given to planning a more varied and stimulating choice of activities, which are suitable for all residents. The attitude and practice of staff promote opportunities for residents to remain independent, exercise choice and express their wishes and needs. The nutritional needs of residents are well considered so that food and mealtimes are seen as being important. EVIDENCE: The home employs an activity co-ordinator who works four hours a day, Monday to Friday. There is a general programme of planned small group activities such as bingo, dominoes and newspaper reviews. A small group of residents also enjoy watching videos of popular musicals and there are regular visits by outside entertainers. Recent outings have included trips to Southend Upminster Nursing Home DS0000062200.V339022.R01.S.doc Version 5.2 Page 15 and Lakeside shopping centre. One resident said that she had enjoyed this shopping trip:”It was lovely, we didn’t get home until 9 o’clock”. Whilst there is a general programme of activities for the home, consideration needs to be given to planning a more varied and stimulating choice of activities, which are suitable for all residents. For example more individual activities and small group activities focusing on the individual’s needs and cognitive functioning, and adapting activities to relate to the individual’s likes and dislikes, past and present. The manager and staff are aware of promoting issues of equality and diversity and the respect of individuals’ beliefs and cultures. This was evidenced on care plans and in discussion with staff by the recording and understanding of any specific religious observances and how this can be enabled for residents. Two residents are practising Catholics and it was important for them to have a set of Rosary beads to hand. One resident confirmed that she receives Communion from the priest fortnightly. Roman Catholic and Church of England services are also held regularly in the home and other residents are enabled and supported to go to their preferred place of worship. There is a weekly visit by a hairdresser and she has the use of a room with a specialist washing basin. Some residents are taken out by their relatives and are encouraged and enabled by the home to do this. The visitors signing –in book shows a steady stream of visitors to the home during the day and on the day of the inspection at least five residents had visitors. Visiting times are flexible and visitors confirmed that they could visit at any time. One relative spoken to said: “I do shift work and can arrive at any time but the staff do not have a problem with it”. Throughout the visit the inspectors observed staff allowing time for residents to express their wishes and supporting individuals to make choices in their everyday lives, for example choosing a drink and where they wished to sit or eat their meal. On the day of the visit the weather was very warm and staff were regularly observed offering cold drinks to residents; ensuring residents were comfortable in their choice of clothing and using fans in lounges and bedrooms. Meals are most served in the dining room on the ground floor, though residents can also choose to take their meals in the quiet lounge or their bedrooms, which some residents chose to do. Though there are sufficient dining tables, many of the residents prefer to eat in the lounge chairs with small tables in front of them. During the inspection some residents were observed having a late breakfast; one resident was having a sandwich and another resident had just finished a meal of bacon and beans on toast. Most of the residents spoken to said that the food was “okay” and two residents said:”The food is nice”. Upminster Nursing Home DS0000062200.V339022.R01.S.doc Version 5.2 Page 16 Menus were inspected and found to be balanced and a choice is offered each day. The serving of the lunchtime meal was observed and one resident asked for crackers and tomatoes, as she had a large breakfast and was not hungry; another resident was having sausages and onions for lunch, as she did not like either of the two choices. Some of the residents required assistance with eating and staff were seen to carry out this task appropriately, talking to residents about the meal and not rushing them. The manager has undertaken a catering survey and new menus are to be completed. Residents confirmed that they had completed these surveys, some with the help of staff or their relatives. The manager is also planning to develop some picture menus to assist residents with meal choices. A visit was made to the kitchen and the inspector was able to discuss the storage and preparation of food with the cook. She was fully aware of those residents requiring special therapeutic diets and demonstrated a good knowledge and understanding of the importance of well balanced and well presented meals. A cooked breakfast is available each day and includes bacon, eggs, mushrooms and beans. There are also a variety of cereals, porridge, toast, yoghurts and grapefruit. Fresh fruit is provided daily and is available on request. Upminster Nursing Home DS0000062200.V339022.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): Standards 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The manager and staff make every effort to sort out problems or concerns so that residents and their relatives are assured that their complaints will be listened to and acted upon. Nursing and care staff have received training in safeguarding adults. However, this must be extended to include all staff working in the home to ensure that there is a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has a written complaints policy/ procedure and the complaints log inspected indicated the number of complaints and issues of concern received and included details of investigation, action taken to resolve them and the outcome for the complainant. All complaints are responded to in writing and information about making a complaint is on display in the home. In addition there are Cause for Concern forms, which are available in the reception area and the nurses station. This means that any issues of concern can be addressed quickly and action taken to resolve such concerns to the satisfaction of the complainant. One complaint has been received by the Commission since the last inspection, and has been fully investigated by the registered providers. Those residents and relatives spoken to were aware of how to complain and to whom. Comments included: “I would tell the manager if I had a problem”…….”If I had concerns I would tell my daughter”…….”I really Upminster Nursing Home DS0000062200.V339022.R01.S.doc Version 5.2 Page 18 don’t have any complaints but I wouldn’t hesitate in telling the manager if I did”. There is an in house training programme for staff in safeguarding adults and recognising and reporting abuse. The majority of nursing and care staff have received this training and is now included in induction training for all new staff. The manager must ensure that this training is extended to include all staff working in the home, for example administrative and ancillary staff. Staff spoken during the inspection were aware of the action to be taken if they had concerns about the safety and welfare of residents. The manager was very clear when such incidents and concerns needed to be referred to the local authority as part of safeguarding adult protocols and procedures. A visit was made to the home in November 2006 following concerns around the management of medication. The concerns were investigated through the London Borough of Havering’s, Safeguarding Adults protocol. The organisation worked co-operatively with the Commission and local authority to address these concerns. Upminster Nursing Home DS0000062200.V339022.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): Standards 19, 20, 21, 22, 24 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The environment is well maintained and the décor and furnishings are of a good standard. This provides residents with a clean, safe and comfortable place in which to live. EVIDENCE: The building was toured by the inspectors, accompanied by the manager, at the start of the visit, and all areas were visited later during the day. Since taking up post the manager has undertaken a review of the environment and facilities in the home and prioritised areas requiring action. Some bedrooms were seen either by invitation of the residents, whilst others were seen because the doors were open or being cleaned. Residents are encouraged to personalise their bedrooms and all of the bedrooms seen were Upminster Nursing Home DS0000062200.V339022.R01.S.doc Version 5.2 Page 20 very personalised and representative of the occupant’s interests, culture and religion. There is a call alarm system fitted to each bedroom, and is located within easy reach of each resident’s bed. All bedrooms are of a good size with good quality furnishings and generous sized en suite toilets and washbasins. However, all bedrooms doors have a clear glass observational panel, which does not afford residents total privacy. The manager is fully aware of this and arrangements are in hand for pictures or other methods of obscuring the glass panels to be fitted. Net curtains are also being hung in bedrooms that are on the ground and lower floors to also ensure the privacy of the occupants. It was noted that some bedrooms were being used to store boxes of enteral feeds and nutritional supplements. Whilst it is acknowledged that these are for the use of the occupant’s of the rooms, it is not acceptable to store surplus stocks in residents’ rooms, as it impinges on their individual, space, comfort and privacy. The manager made arrangements for these boxes to be stored elsewhere. The communal areas of the home consist of one large lounge/ dining room from which the garden can be accessed and a smaller ‘quiet’ lounge. At the time of the visit the maintenance person was fitting balustrades to the French windows in the dining area, which is on the first floor. The manager had identified a potential health and safety risk to residents and had taken action to secure safe access to the windows accordingly. There are plans to convert the shower room on the ground floor into a wet room, as it is difficult to access with a wheelchair. The nurses’ station is located in the lounge, occupies quite a large area and impinges on residents communal space. Discussions took place with the manager about were else in the home the nurses station could be located. There is toilet which is situated directly off the main lounge and is rarely used. The manager is proposing that this toilet be revamped and used as a staff office. The inspectors would support this as it would increase the space in the lounge for residents use; provide staff with more appropriate facilities for care plans and other records; and there is an existing large toilet directly adjacent to the lounge, which most residents currently use. The manager has changed the cleaning schedules and products used. On the day of the visit there were no offensive odours and the home was clean and tidy throughout. The standard of décor, furnishings and fittings are being maintained to a good standard. The walls in the corridor appeared rather bare and could benefit from being brightened up by the hanging of some interesting pictures. There is an ongoing programme of refurbishment and re-decoration. The home employs a maintenance person and there is an effective system in place for the staff to report items requiring attention or repair. The garden is well maintained and fully accessible to residents. A gardener visits fortnightly. The manager has received information and is fully aware of the recent legislation regarding smoking in care homes, which comes into effect on the 1st Upminster Nursing Home DS0000062200.V339022.R01.S.doc Version 5.2 Page 21 July 2007. The registered providers must ensure that the smoking environment complies fully with the Health Act 2006, Smoke-free (Premises & Enforcement) Regulations 2006; this is to ensure the health of residents. The manager may also wish to make reference to the Royal College of Nursing (RCN) recent best practice guidance for staff and managers on Protecting Community staff from exposure to second-hand smoke. This will ensure that there are adequate systems in place for the protection of staff working in the home. The laundry area was visited and this was found to be clean, with soiled articles, clothing and foul linen being appropriately stored, pending washing. Laundry staff were aware of health and safety regulations with regard to handling and storage of chemicals. Personal Protective Equipment (PPE) such as clothing, gloves and masks were available and in use however, the manager must ensure that goggles are also provided and appropriately used. Hand washing facilities are prominently sited and staff were observed to be practising an adequate standard of hand hygiene. Upminster Nursing Home DS0000062200.V339022.R01.S.doc Version 5.2 Page 22 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 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Staffing levels are satisfactory and there are sufficient staff on duty to meet the individual assessed needs of the residents. The procedures for the recruitment of staff are robust and provide safeguards for people living in the home. EVIDENCE: Staffing rotas were inspected and the staffing levels of qualified nurses and care staff were sufficient to meet the nursing and care needs of all residents. Staff were being deployed effectively to ensure that residents choosing, or needing to remain in their bedrooms were being cared for appropriately. Since the last inspection a number of nursing and care staff have left the service, including three members of nursing staff who have been dismissed following disciplinary action. There is currently a high usage of bank staff however, all of these individuals are on bank contracts and are employed on a regular basis. This is clearly to the benefit of residents since it provides consistency of care. A Registered General Nurse (RGN) is due to commence employment in a couple of weeks and all other vacant posts will be advertised in the near future. Upminster Nursing Home DS0000062200.V339022.R01.S.doc Version 5.2 Page 23 The duty rota was examined and this concurred with the designation and number of staff on duty at the time of the visit. Staff interacted well both with each other and the residents. Havering Care Homes Limited; as an organisation, employs a workforce from diverse cultures and backgrounds. It was apparent at the time of the inspection that generally the ethnicity of the staff team was different to that of the people living in the home. In discussion with the manager and staff they were able to demonstrate an awareness of the importance of understanding and appropriately meeting the needs of all residents, wherever possible around equality and diversity issues. It is important that the manager continues to reinforce this awareness through staff training and supervision. This will ensure that the spiritual, dietary, cultural, sexual and any other diverse need of service users at Upminster Nursing Home is met through meaningful ‘person centred’ care. A random sample of the files of the four most recently appointed staff were examined. These were found to be in good order with necessary references, Criminal Records Bureau (CRB) disclosures, current status with the Nursing & Midwifery Council (NMC) and application forms duly completed. It was evident that the recruitment procedures are robust and in accordance with the Care Homes Regulations. Discussions with staff and inspection of training records evidenced that staff had undertaken training in essential areas such as fire safety, moving and handling, food hygiene and infection control. The manager has identified future training for staff including palliative care, care planning using the new documentation, safeguarding adults and addressing dignity and privacy issues through role-play. Medication training for nursing staff is planned for the end of June and the planned training schedule has identified future training for key staff in vene-puncture. From viewing staff records and talking to staff, it was evident that arrangements are in place for staff to receive regular supervision. The preinspection questionnaire completed by the manager states that out of eleven care staff only two are qualified to NVQ level 2 or above. However, this low number is reflective of recent staff turnover. The manager is aware of the need for more care staff to be working towards this qualification. She is an NVQ Assessor and is confident that an increase in qualified care staff can be achieved. Upminster Nursing Home DS0000062200.V339022.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): Standards 31, 32, 33, 35 & 38 People using the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. The manager of the home is a well qualified and experienced person and residents benefit as the home is run in their best interests. Monitoring visits are undertaken regularly by the responsible individual to monitor and report on the quality of the service being provided in the home. Staff are appropriately supervised and the health, safety and welfare of residents and staff are promoted and protected. Upminster Nursing Home DS0000062200.V339022.R01.S.doc Version 5.2 Page 25 EVIDENCE: The manager has only been in post since March this year and her application to be registered as the manager is currently being progressed by the Commission’s Central Registration Team. She holds a registered nursing qualification and has the relevant qualifications and experience to manage the home. She has a clear understanding of what improvements are needed and the key areas in which the home needs to further develop. The home has also appointed a deputy manager who holds registered nursing qualifications in both general and mental health nursing. Six supernumerary hours each week have been identified to allow him to undertake training with staff work including work on care planning. Since the manager took up post she has had meetings with residents and relatives where she has set out her vision for the home, which is to provide an increased quality of life for people living in the home. She is very resident focused and with the support of the deputy manager she is committed to build a strong staff team and work continuously to improve the service, in partnership with the families of residents and professionals. Comments from residents, relatives and staff were all very positive. They have found the manager to be “helpful, supportive…… and is managing the home in the best interest of the residents”. The responsible individual undertakes Regulation 26 monitoring visits on a monthly basis to monitor and report on the quality of the service being provided in the home. A copy of the report is sent to the Commission. Currently the manager does not act as an appointed agent for any resident. Residents’ financial affairs are managed by their relatives/ representatives. The home has responsibility for the personal allowances of several residents. Through discussion with the administrator and records inspected, there was evidence to show that residents’ financial interests are safeguarded. Secure facilities are provided for the safekeeping of money and valuables held on behalf of residents’. A discussion took place with the manager around the recently introduced Mental Capacity Act 2005, which became effective for those people who do not have family or friends from April 2007, and for everybody from October 2007. It is important that this is discussed with people living in the home, staff and relatives, and that the organisation ensures that staff undertake adequate and appropriate training in this important area. A wide range of records were looked at including fire safety, emergency lighting, water temperature checks, gas and electrical certificates and accident Upminster Nursing Home DS0000062200.V339022.R01.S.doc Version 5.2 Page 26 incident records. These records were found to be detailed, up to date and accurate. A fire risk assessment was undertaken in May 2007 and an emergency fire plan was completed in March 2007. Upminster Nursing Home DS0000062200.V339022.R01.S.doc Version 5.2 Page 27 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 X 2 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Upminster Nursing Home DS0000062200.V339022.R01.S.doc Version 5.2 Page 28 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 OP7 OP11 Regulation 12 & 15 Requirement The registered persons must ensure that all care plans are updated accordingly to reflect changing needs, and include End of Life choices and decisions. The registered persons must review the current general activities programme so as to provide a more varied and stimulating choice of activities, which are suitable for all residents. The registered persons must ensure that the training in safeguarding adults is extended to all staff working in the home, including, administrative and ancillary staff. This will ensure that there is a proper response to any suspicion or allegation of abuse. The registered persons must ensure that more suitable arrangements are made for the storage of surplus stock, such as nutritional supplements. This will ensure that the storage of such items does not impinge on the individual residents bedroom DS0000062200.V339022.R01.S.doc Timescale for action 31/07/07 2. OP12 16(2)(n) 31/08/07 3. OP18 12 & 18 30/09/07 4. OP24 23(2)(l) 23/05/07 Upminster Nursing Home Version 5.2 Page 29 5. OP28 18(1)(c) (i) (ii) space, comfort and privacy The registered persons must ensure that care staff employed to work in the home receive training appropriate to the work they are to perform, including support to enrol and obtain further qualifications. 30/09/07 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 OP19 Good Practice Recommendations It is strongly recommended that the current location of the nurse’s station be reviewed. This will increase the space in the lounge for residents use and provide staff with more appropriate facilities for care plans and other records. Upminster Nursing Home DS0000062200.V339022.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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 Upminster Nursing Home DS0000062200.V339022.R01.S.doc Version 5.2 Page 31 - 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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