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Inspection on 31/05/05 for Upminster Nursing Home

Also see our care home review for Upminster Nursing Home for more information

This inspection was carried out on 31st 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

The home carries out initial assessments prior to anyone being admitted to the home. This is to ensure that the home can meet the needs of the proposed service user before they come into the home. The home is being refurbished with new carpets, furniture and redecoration of bedrooms. Service users and relatives spoken with during the inspection said they were happy with the service the home provided and had no concerns.

What has improved since the last inspection?

The completion of peg feed charts is now being carried out appropriately, this enables the home to show they are giving the feed in line with the dieticians instructions. The complaints procedure now has the correct telephone number for the Commission for Social Care Inspection, so anyone not wishing to make a complaint to the home can do this directly with the Commission. The Statement of Purpose has been amended.

What the care home could do better:

Closer monitoring of care plans is necessary to ensure that all the care needs of service users are documented and updated as changes take place. A service user who has a care plan for `pain` control did not have a corresponding `pain control` chart. Therefore the home cannot evidence that they were providing adequate pain control. After this was pointed out to the acting manager a chart was put into place. There was no wound assessment chart for one service user who had wounds that were being dressed regularly, this is poor practice. Although the complaints procedure details the action to be taken when a complaint was raised, for one person who raised a verbal complaint this was not documented. The inspector was unable to see what action had been taken by the home when the complainant made the same complaint to the Commission. This complaint was not able to be investigated fully due to lack of information. All complaints must be recorded at the time they are made. A random selection of beds were inspected some of the beds were found to have stained and torn linen on them. These beds were made up ready for reuse this is poor practice and must be addressed. The home must monitor the bed making.

CARE HOMES FOR OLDER PEOPLE Upminster Nursing Home Clay Tye Road Upminster Essex RM14 3PL Lead Inspector Rhona Crosse Unannounced Inspection 31 May 2005 - 8.30 am 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. Upminster Nursing Home G55_S62200_Upminster_V222434_310505_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Upminster Nursing Home Address Clay Tye Road, Upminster, Essex, RM14 3PL 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) 01708 220201 01708 641420 Havering Care Homes Ltd Vacant CRH - N Care Home with Nursing 31 Category(ies) of OP Old age - 30 places registration, with number PD(E) Physical disability over 65 - 1 place of places Upminster Nursing Home G55_S62200_Upminster_V222434_310505_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the registration shall be subject to the condition that Havering Care Homes Ltd will not increase the number of service users resident in the home at any time without first obtainining written confirmation from the CSCI that it is satisfied:[i] That a sufficient number of suitably qualified, competent and experienced persons are working at the home in such numbers as are appropriate for the health and welfare of the proposed increased number of service users; and [ii] That there has been a satisfactory and sustained improvement in the carrying on of the home since the date of the settlement or (as the case may be) the date of any previously agreed increase in the number of service users resident in the home. 2. That it will not less than once in every month, as part of its compliance with Regulations 15(2)(b) and 24(1)(a) and (b) of the Care Homes Regulations perform a detailed analysis, using a methodology approved in advance by CSCI, of the quality of nursing care provided to representative samples of [i] service users, with pressure care needs; and [ii] service users requiring PEG feeding and will submit the results of such analysis to the CSCI. 3. That it will not less than once every six months commission a review by an appropriately qualified expert in nursing care who shall assess the effectiveness of the analyses performed under sub-paragraph 2 above, and it will submit a written report of such an expert to the CSCI. Date of last inspection 24 February 2005 Upminster Nursing Home G55_S62200_Upminster_V222434_310505_Stage 4.doc Version 1.30 Page 5 Brief Description of the Service: Upminster care home is a home providing 24 hour nursing, currently for 31 older people (see previous page regarding conditions of registration). It is situated in a rural area between Upminster and North Ockendon. 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 most rooms have an en-suite with a toilet and wash hand basin. The home has wheelchair access and a passenger lift is provided. Upminster Nursing Home G55_S62200_Upminster_V222434_310505_Stage 4.doc Version 1.30 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection which means that the home did not know the inspector was coming. Not all standards were inspected at this inspection. The remaining core standards will be inspected at the next inspection. The inspector looked a random selection of care plans, nursing records and daily records. A medication audit was also carried out by the inspector. Discussions took place with service users and relatives who were visiting during the time of the inspection. The lunchtime meal was observed, two staff members were seen standing up whilst feeding service users, carers should be seated when assisting service users with their meals. One service user would benefit from specialist cutlery being provided to enable her to feed herself comfortably. There was a choice of two main meals and portions were observed to be individual sizes. A random selection of bedrooms were inspected along with the external grounds of the building, work is required to maintain the external walls of the property and grounds. Since the last inspection there has been a new manager appointed. The new manager has put forward an application for registration with the Commission. The new acting manager has been at the home since April 2005. No changes to the current documentation have been made and the manager has stated that her time at the home has been spent getting to know the service users and monitoring the staff practice and how the home operates. Attention to detail and monitoring of care plans and nursing records must be undertaken more fully as there was missing information that related to the health and welfare of service users. Medication practices also require closer monitoring. Whilst the majority of health and safety areas were well managed, the fridge and freezer temperatures must be recorded daily. A fridge in the kitchen requires a seal replacing and the fridge freezer in the kitchen require replacing as it is rusty and has a broken handle. What the service does well: The home carries out initial assessments prior to anyone being admitted to the home. This is to ensure that the home can meet the needs of the proposed service user before they come into the home. The home is being refurbished with new carpets, furniture and redecoration of bedrooms. Upminster Nursing Home G55_S62200_Upminster_V222434_310505_Stage 4.doc Version 1.30 Page 7 Service users and relatives spoken with during the inspection said they were happy with the service the home provided and had no concerns. 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. Upminster Nursing Home G55_S62200_Upminster_V222434_310505_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 Upminster Nursing Home G55_S62200_Upminster_V222434_310505_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. The home does not provide the service standard 6 applies to. These standards were met with information being readily available. The home are undertaking appropriate assessments to ensure admissions are appropriate and in the best interests of the service users. EVIDENCE: The Statement of Purpose and the Service Users Guide is given to prospective service users. These documents have the information to enable service users to know what the home will provide. From a random selection of service users’ files it was observed that the home carryout their own pre assessments prior to admission for all service users. Copies of the local authorities assessments were also seen in service users’ files. Upminster Nursing Home G55_S62200_Upminster_V222434_310505_Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, and 9. The home ensures that appropriate referrals to health professionals. Although some records are appropriately completed (such as fluid and turn charts) the home must tighten up its recording in some key areas. Those gaps identified below can put service users at risk. EVIDENCE: From a random selection of service user’s care records it was seen that the majority of care plans were being updated. The manager stated that she was monitoring care plans on a weekly basis (approximately 6 at a time). However for one service user the care plan for pressure care stated on the 13/4/05 that the skin was intact, no further update was made on this care plan. The daily records stated on the 19/4/05 that the area was being dressed and this continued with a GP visit dated 27/4/05 when a cream was prescribed for the area. The wound assessment plan made no reference to the Fucibet cream being prescribed for use, the record stated that a specific dressing (Tegaderm) and Cavalon spray was in use. This wound assessment should have been updated to show the current cream prescribed for use. Other areas of care for this service user were recorded and updated appropriately. For another service user who has a catheter. The records stated that they should have a daily bladder wash out. Further documents cross referenced Upminster Nursing Home G55_S62200_Upminster_V222434_310505_Stage 4.doc Version 1.30 Page 11 identified that the GP had changed this to bladder wash outs twice weekly (on 28/2/05), however the care plan had not been updated. No record of bladder wash outs could be found in either the daily records, continuing care plan or on the medication administration sheets. The information in relation to bladder wash outs on the medication administration sheet (the most up to date information) was that bladder wash outs were to be undertaken now ‘when necessary’. The home must ensure that when changes are made to medical needs that the care plan is updated to show this (at present there are three conflicting pieces of information relating to the this). The same service user has a history of uncontrolled pain and is taking very strong medication to relieve this. There is a care plan for this pain, but no ‘pain’ score chart was being completed as specified in the care plan. This was put into practice after the inspector raised this concern. For a further service user who came into the home with broken areas to the buttock and both heels, there is no care plan for these areas and no wound assessment chart. In discussion with the manager, she stated that no wound assessment chart had been completed as she had not yet taken a photograph of the wounds. However the wound assessment chart should not be dependent on a photograph and should commence as soon as a skin problem is identified. Other areas of this person care planning was appropriately completed and reviewed. Two other service users records were well maintained with information correctly recorded and appropriately reviewed. Peg feeding charts were appropriately completed. Referrals to other health professionals was seen to be well documented with input from the GP, Dietician, Speech and Language Therapists and Tissue Viability Nurses. An audit of medication records and medication held in the home was made. Controlled drugs were appropriately recorded and medicine held corresponded with records made. The medication administration sheets were inspected along with the medication in the monitored dosage system. For one service user Maxijul was signed as being administered on the 24/5/05 am and pm. However the instructions from the manager were that the amount of medication must be checked with the pharmacy prior to any being administered. For another service user an antibiotic (Trimethoprim SF suspension 50mg/5mls) was to be administered at 9p.m. The start date for this medicine was the 9/5/05; two signatures on the medication administration sheet showed that 10mls had been given (5mls per night) the record then stated ‘course completed.’ However, the amount recorded as received into the home Upminster Nursing Home G55_S62200_Upminster_V222434_310505_Stage 4.doc Version 1.30 Page 12 on the 9/5/05 was 100mls (only 10mls could be accounted for). There was no record of this medicine being discontinued or returned to the pharmacy. The manager must investigate this matter and provide a report to the Commission of her findings. Upminster Nursing Home G55_S62200_Upminster_V222434_310505_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) 14 and 15. Specialist cutlery is required for one service user who was attempting to feed herself with difficulty due to the cutlery she was using. This must be addressed. Meals were well presented and of individual portions, showing that choice is taken into consideration. EVIDENCE: 3 relatives were visiting at the time of the inspection and were complimentary about the service the home provides. A service user stated that she ‘liked the food and there was plenty of it’. Another service user in her room had left her meal as she said ‘there was no taste to it, I want some salt’. Staff brought salt and pepper to her on request. The service user went on to say of the member of staff that ‘she’s nice, she brings me a nice cup of tea in the morning and she’s a nice girl’. The main meal of the day was beef cobbler or toad in the hole. Vegetables provided were runner beans and mashed potato. Pudding to follow was bread and butter pudding with custard the alternative was fresh fruit. Several pureed meals are prepared. Some service user’s prefer to eat their meals in their rooms and this shows the home are giving people a choice of Upminster Nursing Home G55_S62200_Upminster_V222434_310505_Stage 4.doc Version 1.30 Page 14 where to eat. One service user was having difficulty with the cutlery as she has had a stroke and could only use one hand. The home must provide more appropriate specialist cutlery to enable anyone with specific needs to remain independent and enjoy meal times. Two staff were observed standing up over service users when they were feeding them. This is poor practice and must be addressed. There is a four week menu and the week currently in use is week 4. The cook had prepared a chocolate sponge for the tea time meal which was to be served with cream and fresh fruit, a portion was provided to the inspector the sponge was excellent. In discussion with a service user she said that ‘yes, I am able to choose when to go to bed although most times I am happy to go when the girl’s come and ask me but I could stay up if I wanted to’. ‘I like the food, you get plenty of it’. Upminster Nursing Home G55_S62200_Upminster_V222434_310505_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 . Standard 18 will be inspected at the next inspection. One complaint was not managed appropriately. However on the day of the inspection a concern was dealt with appropriately. An outstanding requirement from the last inspection has not been met as this is in relation to adult protection this is deemed as poor practice. EVIDENCE: A complaint was made to the Commission about the care of a past service user. This complaint was investigated as part of the inspection process. Complaints records, staff rotas and the visitors signing in and out book was also inspected for the autumn/winter of 2004. It was established that the complainant has raised the concern about the attitude of staff with the home’s administrator. However this complaint had not been recorded at the time. The complainant raised several other issues that could not be substantiated due to lack of dates, times and names of staff being provided by the complainant and lack of recording by the home. Any dissatisfaction with the service must be recorded and the action taken also recorded, along with whether the complainant is satisfied with the homes investigation. During the inspection a service user who was not happy and had only recently been admitted to the home came to the office. Both the manager and the administrator took time to listen to her concerns. It was a requirement at the last inspection that the adult abuse procedure should include written instructions or a flow chart for staff to follow if they suspect abuse or abuse is alleged. This has not been achieved. Upminster Nursing Home G55_S62200_Upminster_V222434_310505_Stage 4.doc Version 1.30 Page 16 Upminster Nursing Home G55_S62200_Upminster_V222434_310505_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, 21, 22, 23, 24, 25, 26. The home is being refurbished and many rooms have had new carpets and furniture and have also been decorated. Several rooms on the first floor are in the process of being decorated. However monitoring of bed making should take place to ensure that all beds are suitable for use. The external grounds are unkempt with weeds and grass growing high above any planting in them. In the past formal action has had to be taken to get the home to keep the grounds to a reasonable standard. This must be addressed urgently. Further maintenance is required to the external walls of the building and woodwork. These external repairs were requirements made at the last inspection. A shorter timescale will be given to address these at this inspection. EVIDENCE: A random selection of bedrooms were inspected. On the top floor bedroom 33 had been decorated and new carpets and furniture was provided with a specialist bed also in this room. The manager was not sure how many rooms Upminster Nursing Home G55_S62200_Upminster_V222434_310505_Stage 4.doc Version 1.30 Page 18 had been decorated and refurbished. It is recommended that a log of all decorating a refurbishment is kept by the home. Cleaning had taken place on the ground floor and was continuing throughout the building. The majority of rooms inspected were clean and free from odours. However the fan in the en-suite of bedroom 32 had been switched off, this was switched on and was found to be working. Fans in en-suites without windows must not be switched off at the fuse. In bedroom 28 there was an odour of urine coming from the carpet (this room had not been cleaned). The inspector checked the bedding, one pillow case was soiled, the bed had been made up ready for re-use. In bedroom 26 the bed was poorly made with a torn bottom sheet. Linen should not be placed on beds unless it is fit for use. It is of concern that these are areas that have been the subject of Immediate Requirement Notices in the past. The new manager must monitor the beds/bedding to ensure that they are all fit for use. The Commission will check bedding at further inspections. In the en-suite of this bedroom a night catheter bag was left on the W.C. cistern full of urine. This is poor infection control. On the lower ground floor bedroom 2 had no bottom sheet over the mattress. The duvet was pulled up over the mattress. However the rest of the room was clean. Service users are able to bring personal possessions and small pieces of furniture when they are admitted to the home, these were seen as the inspector checked the home. Specialist mattresses and cushions are provided to aid pressure relief and also specialist beds are also provided if it is necessary. Lifting and handling aids and hoist are also provided by the home. There were two cracked tiles in the shower room and one bathroom was said to be out of action as there was a leak in the pipe work. The plumber was to attend to the leak on the 1/6/05. The laundry was clean and tidy and well organised. Clothing was appropriately stored waiting to be laundered. The home has one commercial size washing machine and is awaiting a replacement of the second washing machine that has been removed. No date has been given for the renewal of this. The tumble dryer was in working order. The sluice room was clean and tidy with soap and paper towels available for hand washing. Clinical waste was appropriately stored both inside and outside in the external clinical waste bins. Feeding beakers were seen to be scored and stained and not suitable for use. These were taken to be cleaned by the kitchen staff. The manager must ensure that all utensils provided to service user are fit for use at all times. The large dresser in the dining area next to the serving hatch was found to have old Upminster Nursing Home G55_S62200_Upminster_V222434_310505_Stage 4.doc Version 1.30 Page 19 food debris (which was hard and stuck in to it). This dresser requires a thorough cleaning. The grounds are poorly kept with weeds and grass growing over the top of any planting. At the time of the inspection a gardener was being shown around the grounds. The home should have ensured that the grounds were not allowed to become overgrown again. This must be urgently addressed. Planting of these areas is recommended to give an outlook to service users when in the lounge. The tarmac path and seating area has been repaired. The external walls of the building have cracks and these require repair and painting. Woodwork and window frames also require maintenance. Upminster Nursing Home G55_S62200_Upminster_V222434_310505_Stage 4.doc Version 1.30 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 standard 30 will be inspected at further inspections. There has been a sustained improvement in the recruitment and employment practices of the home, this process ensures the safety of vulnerable service users. EVIDENCE: The documentation for the recruitment and selection of staff was seen to be in order for a random selection of staff. There is a skill mix within the staff group and a ‘core’ of staff who have been working at the home for a long period of time and know the needs of service user’s very well. At present the ratio of staff to service users is said to be 1-5. Staff training is taking place and for 2005 training that has already taken place is elder abuse 15/3/05, lifting and handling 14/3/05, fire safety 25/2/05 and first aid training on the 23/4/05. Upminster Nursing Home G55_S62200_Upminster_V222434_310505_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) 30, 38, standards 33 and 35 will be inspected at the next inspection. Since the last inspection there has been a new manager appointed. The new manager has not applied for registration with the Commission and must do as a matter of urgency. Although the majority of the health and safety section was well managed with information readily available, the fridge and freezer temperatures had several missing records and feeding beakers were stained, therefore this standard is not met. The identified shortfall could have a detrimental effect on service users. There is slippage in some key areas, which had been subject to significant improvement with the previous manager. The registered person must address this to maintain continuous improvement. EVIDENCE: The health and safety documents the home have to keep were inspected. The fire alarm call points are being tested weekly. The fire alarm was serviced on the 6/2/05 and the fire extinguishers received their a yearly check on the 13/10/04. Fire drills are taking place, however the last drill was recorded as Upminster Nursing Home G55_S62200_Upminster_V222434_310505_Stage 4.doc Version 1.30 Page 22 3/9/04. The home should ensure that they carry out fire drills more frequently. All new staff must attend a drill as soon as possible. The home should carryout a fire drill a minimum of 4 times a year. Emergency lighting was checked on 1/2/05. The 5 year electrical safety certificate was dated 2/6/04 and the portable electrical appliance test is being completed this month by a qualified electrician. The lifting hoists were serviced on the 14/5/05 and the passenger lift was serviced on the 15/3/05. The annual Gas safety certificate was dated 20/9/04. The nurse call alarm system was tested on 16/4/05. The Legionella test was carried out on the 6/10/04. The fridge and freezer temperatures were not being taken and recorded daily (5 dates where not recorded) this must be done. There was a leak from the fridge in the kitchen, when the inspector looked at the fridge it was discovered that the seal on the door had perished and needs to be replaced. The fridge/freezer in the kitchen has a broken handle and the body of the fridge is rusty this requires replacement. Feeding beakers were seen to be very scored and stained. All beakers should be clean and free from stains at all times. A stock of new feeding beakers should be kept by the home to ensure that these can be replaced as they become worn and no longer suitable for use. Upminster Nursing Home G55_S62200_Upminster_V222434_310505_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 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 2 COMPLAINTS AND PROTECTION 2 2 2 3 3 2 3 2 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x 2 x x x x x x 2 Upminster Nursing Home G55_S62200_Upminster_V222434_310505_Stage 4.doc Version 1.30 Page 24 No 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. 2. 3. Standard OP7 OP8 OP8 Regulation 15(1) 17(1)(a) schedule 3 3(k) 17(1)(a) sechedule 3 3(k) 13(2) Requirement All care plans must be kept updated as changes occur. A wound assessmsnt tool must be completed for anyone requiring dressings to a wound. A pain chart must be completed for anyone who requires pain control/monitoring. Suitable arrangement must be made for the recording, handling, safekeeping and safe administration and disposal of medication. Provide appropriate cutlery for the service user who has had a stroke Ensure that staff are seated when feeding service users. A record of all complaints must be kept. Timescale for action 30/8/05 30/6/05 31/5/05 and ongoing action. 30/8/05 4. OP9 5. 6. OP14 OP14 16(2)(g) 12(1)(b) 30/7/05 31/5/05 and ongoing action. 30/8/05 7. 8. OP16 OP18 17(2) schedule 4 11 13(6) 9. OP19 23(2)(b) The adult abuse procedures must 30/7/05 have written instuctions or a flow chart for staff to follow if they suspect abuse or abuse is alleged The external walls must be 30/9/05 repaired and painted. The Version 1.30 Page 25 Upminster Nursing Home G55_S62200_Upminster_V222434_310505_Stage 4.doc 10. OP20 23(2)(o) 11. 12. 13. OP21 OP24 OP26 23(2)(b) 16(2)(c) 16(2)(k) woodwork to windows/doors also requires staining/painting. The grounds of the building must be appropraitely maintained at all times. All overgrown weeds/grass to be removed Repair the 2 broken tiles in the shower room. Bedding must be suitable for use at all times. Ensure the odour of urine is removed from the carpet in bedroom 28. This carpet may require daily shampooing. Ensure that feeding beakers are kept clean and free from staining at all times. Clean the dresser in the dining area next to the serving hatch and ensure that this remains free from stuck on food and food spills. The acting manager must apply to the Commission for registration Fire drills must take place at regular intervals. All new staff must attend a fire drilll. Replace the seal on the stainless steel fridge in the kitchen. Ensure the fridge and frezer temperatures are taken and recorded daily. Replace the fridge/freezer in the kitchen that is rusty and has a the broken door handle. Ensure catheter bags are not left in en-suites full of urine. 30/7/05 30/6/05 31/5/05 and ongoing 30/6/05 14. 15. OP26 OP26 13(3) 13(3) 31/5/05 and ongoing. 30/6/05 16. 17. 18. 19. 20. 21. OP31 OP38 OP38 OP38 OP38 OP24 8 23(4)(e) 23(2)(c) 16(2)(j) OP2(2)(c) 13(3) 30/6/05 30/7/05 30/7/05 31/5/05 and ongoing. 30/7/05 30/6/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Upminster Nursing Home G55_S62200_Upminster_V222434_310505_Stage 4.doc Version 1.30 Page 26 No. 1. 2. Refer to Standard OP19 OP20 Good Practice Recommendations It is recommended that the home keep a record of all refurbishment and decoration. It is recommended that plants are put into the borders near the lounge to give a pleasant outlook for service users. Upminster Nursing Home G55_S62200_Upminster_V222434_310505_Stage 4.doc Version 1.30 Page 27 Commission for Social Care Inspection Ferguson House 113 Cranbrook Road Ilford, Essex IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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