Inspection on 05/12/05 for Upminster Nursing Home

This inspection was carried out on 5th December 2005.

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

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

Other inspections for this house

Upminster Nursing Home 23/05/07

Upminster Nursing Home 11/08/06

Upminster Nursing Home 08/05/06

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 Rhona Crosse Unannounced Inspection 5th December 2005 09:15 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.V270872.R01.S.doc Version 5.0 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.V270872.R01.S.doc Version 5.0 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 Mrs Phidelima Ajao Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (33), Physical disability over 65 years of age (1) of places Upminster Nursing Home DS0000062200.V270872.R01.S.doc Version 5.0 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 obtaining 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 impovement 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. 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 3. and will submit the results of such analysis to the CSCI. That it will not less than once every six months commission a review by an appropriately qualified independent expert in nursing care who shall assess the effectiveness of the analyses performed under subparagraph 2 above and it will submit a written report of such an expert to CSCI. 2. Upminster Nursing Home DS0000062200.V270872.R01.S.doc Version 5.0 Page 5 Date of last inspection 31st May 2005 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 DS0000062200.V270872.R01.S.doc Version 5.0 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced therefore the home did not know the inspector was coming. The inspector arrived at approximately 09.15. The areas inspected were care planning, risk assessments, heath and welfare, medication, daily records, adult protection, staff training and recruitment and the premises. Discussions took place with service users. Service users spoken with were happy with the service the home provides. There were some areas of good practice seen as part of the inspection process. Several areas of health care were well met for some service users whose files were inspected at random. However the home is not being run in the best interests of all service users. A number of requirements made at the last inspection have not yet been met and have been restated in this report, with new timescales for compliance. In the ‘Timescale for Action’ column, the date in ordinary type relates to the timescale given at the last inspection. The date in bold type relates to the new timescale. Unmet requirements impact upon the welfare and safety of service users. Failure to comply by the revised timescale will lead to the Commission for Social Care Inspection considering enforcement action to secure compliance. The manager failed to take appropriate action when an allegation of rough handling was reported to her, thus placing vulnerable service users at risk. There are currently 2 ongoing adult protection investigations being undertaken. The quality of care provided by the home (for some service users) has fallen below the National Minimum Standards and this raises concern with the Commission. This home had previously had legal action taken against them as they did not provide adequate care. From this inspection and relating records service users are being placed at risk due to poor care practice. The Commission are currently considering what action it takes in relation to this What the service does well: Infection control had improved and in discussion with one domestic she was able to describe appropriately the process of infection control to be carried out in some bedrooms. The health and safety documentation was in good order. Upminster Nursing Home DS0000062200.V270872.R01.S.doc Version 5.0 Page 7 The kitchen is being maintained to a good level of cleanliness. 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 DS0000062200.V270872.R01.S.doc Version 5.0 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.V270872.R01.S.doc Version 5.0 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 the following standard(s): The core standards in this section were inspected at the last inspection and deemed met. These standards were not inspected at this inspection. EVIDENCE: Upminster Nursing Home DS0000062200.V270872.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 9 and 10. At the last inspection in May standards 7 (care plans) and standard 8 (health care needs) were not met and were therefore inspected again at this inspection. Standard 10 was also inspected. The home is not being monitored appropriately in relation to nursing care. The findings below give cause for concern. The quality of nursing care and record keeping must be improved to ensure that service users health and welfare needs are met and that the home operates to an acceptable level. EVIDENCE: Standard 9 (medication) was inspected by the CSCI pharmacy inspector and as a result of this inspection an Immediate Requirements Notice was served due to poor medication practice. An audit trail of medicines in the home was not generally possible due to the date that medication was received into the home was not identified. Medication prescribed part way through the month was not carried forward onto the next medication administration sheet. A random selection of care plans were inspected and it was observed that some care plans lacked the appropriate information. One service user’s care plan had been in part updated (27/11/05) in the absence of the service user Upminster Nursing Home DS0000062200.V270872.R01.S.doc Version 5.0 Page 11 who was in hospital at the time of the update. This is poor practice. The same service user’s care plan for constipation was not updated to show that there had been a change in the care being provided as the person was now requiring enemas to be administered. As the service user had not been eating and drinking enough fluids for a period of 3 days the care plan should have reflected this there was no change to this plan of care to evidence this. A risk assessment carried out on the 21/9/05 scored the service user at 10 (the document states if the person scores 14 or less they are at risk. When there was a change in the condition of the service user’s skin, this was not updated to identify these changes nor was the care plan. This service user’s daily records raised concern when the inspector read this, as an entry made by a trained nurse stated that there were no needles for the diabetic pen to enable the service user to be given insulin for 2 days after admission. The entry went on to state that the manager had been informed of this problem. This is very poor practice and could have placed this service user at considerable risk as this service user had unstable diabetes. The diabetic monitoring chart identifies the times that the blood sugar was taken and the reading are recorded. These show that his diabetes is unstable the lowest reading 2.1mmoll and the highest recorded being 12.2mmoll. The diabetic care plan states: “staff to ensure that Leonard’s blood sugar remains within normal limits 4-8mmols”. The care plan does not identify the frequency of the blood sugar testing. The care plan should identify this. The diabetic monitoring chart is not consistently completed and does not state the frequency of checks to be carried out. There are varying times when this form is completed. There are dates where there is no monitoring recorded on the chart for the 21/9/05, 24/9/05, 25/9/05, 26/9/05, 23/10/05 and 24/10/05 or the 26/10/05. No reason for these omissions is given on the reverse of the diabetic monitoring chart both pages are blank. When the daily records were cross referenced with the diabetic monitoring chart the chart identifies one blood sugar test at 09.00. The daily records identify other checks were carried out. One at 09.30, one at 3.30pm another at 7pm and another at 22.00.hours These should have been recorded on the diabetic monitoring chart. The assessment of any service user should highlight all the care needs required and the home should have everything it requires to meet those needs prior to any admission taking place. Further concern was that the service user was prescribed analgesia or pain control but there was no pain control chart. After a change in the pain relief, the medication Tramadol was prescribed. However for 2 days the service user did not get this medication. It is the homes responsibility to ensure that all changes to medication prescribed are acted upon with medication being provided as quickly as possible for the benefit of the service user. Upminster Nursing Home DS0000062200.V270872.R01.S.doc Version 5.0 Page 12 For another service user where there was a change in care and a bladder washout was prescribed due to urinary problem, this change had not been recorded on the care plan. For another service user the care plan stated that the person had a catheter in-situ. However on cross referencing documentation it was observed that the catheter had been removed but there was no information in the care plan to show this change in care. A Nutritional risk assessment was incorrectly scored. When the needs of the service user were inspected and cross referenced by the inspector it was evident that the needs of the service users were such (due to pressure sores and age range) that the scoring should have been 18 and not 12 as recorded by the home. The service user’s score changed from being ‘at risk’ to being at ‘high’ risk due to these factors that had not been taken into consideration at the time of the assessment. This is poor practice. For a further service user the care plan for the care of Epilepsy had not been updates since 27/10/05. Information about the action staff should take was well recorded. However there was no ‘seizure’ chart to record the type of seizure and the length of time the seizure took to pass, should a seizure take place. Although there was evidence of good practice in other records with information readily retrievable where health care needs were being met for other service users. The above concerns show inconsistency in care and monitoring, these are substantial concerns that must be addressed urgently with closer monitoring by the manager of the care being provided. It was a requirement at the last inspection that care plans must be updated as changes occur, this remains and unmet requirement. In discussion with service users they stated that ‘staff respect my privacy they care for me well’ ‘no one comes into my room before they knock’. Another service users stated ‘I like my door open but they still knock on it before coming in.’ Some service users stay in their bedrooms and take their meals in their rooms. This evidences that the home respects service users rights to privacy and choice. Medication practice was inspected by the CSCI’s Pharmacy Inspector in and as a result of the findings an Immediate Requirement Notice was served on the home to improve their medication practice. As part of this inspection the records of the service user who is currently the focus of an adult protection investigation were inspected. The findings are as follows: Upminster Nursing Home DS0000062200.V270872.R01.S.doc Version 5.0 Page 13 Medication records were inspected there are refusals of medication noted. However the records are poorly completed with crossings out and signatures overwritten with ‘R’ for refusal. Medication charts must not be overwritten and no medication should be signed for prior to being given. This has occurred on the sheet dated 15/9/05 – 25/9/05. There are also gaps where no signature is recorded to show whether medication was administered and no code was used either (9 times on the 17/9/05) there is no entry on the back of the MAR sheet to state why this was. The medication administration sheet for the dates of 26/9/05 – 23/10/05 had crossing out obliterating what is underneath and has entries overwritten on them (5 times). There are also gaps in the medication chart where medication that is prescribed has not been signed as being given and no code has been used. Aspirin 75mgs not signed as administered on the 10, 11, 12, and 17/10/05. The medication Metformin 500mgs prescribed to be taken twice a day 8am and 5pm was not signed as being administered on 15/10/05 5pm and also 8am on the 17/10/05. The medication Flucloxacillin commenced on 6/10/05 28 Fluloxacillin capsules 250mgs one to be taken 4 times a day were prescribed and administered 21.00 hours on the 6/10/05 and the course was completed on 16/10/05 at 21.00 hours. There were 28 capsules prescribed- there are 34 signatures stating this medication was administered on 34 occasions and 3 times when the code ‘R’ used as refusal. This medication has not been given as prescribed and raises concern about the care of this service user. This shows that medication practice remains poor. The Commission will consider what action is to be taken as a result of these findings. Upminster Nursing Home DS0000062200.V270872.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 & 15 Whilst the activities meet the majority of the female service users needs, more input should be made to provide the male service users with appropriate activities. EVIDENCE: The home has an activities co-ordinator who’s role it is to engage in activities and arrange entertainment. Her hours of working are 12-4pm Monday, Tuesday, Wednesday and Friday and 10-2 on Thursdays. The manager stated that the activities were being reviewed by the activities co-ordinator. In discussion with service users they stated ‘we have entertainers in, they are enjoyable, singers come in’ ‘we went out to do our Christmas shopping’ ‘it was cold, we went last month’. The Christmas shopping trip took place on 20/11/05. Activities recorded as taking place were a Barbecue in the summer, a clothes party, where a supplier brings in clothing and slippers for sale. A male singer also visited recently. The manager was not able to give the dates of this entertainment. It was stated that one singer comes in every 2 weeks and is very popular with the service users. Other activities range from beauty sessions, art craft and cooking cakes, knitting and board games. The manager Upminster Nursing Home DS0000062200.V270872.R01.S.doc Version 5.0 Page 15 stated that the activities were being reviewed by the activities co-ordinator. The local Church visit the home every second Sunday of the month. On the 9/12/05 carols are to be sung and afternoon tea will be served with mince pies. The homes Christmas party is to take place on the 16/12/06 with entertainment provided. Upminster Nursing Home DS0000062200.V270872.R01.S.doc Version 5.0 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18. The other core standard formed part of the last inspection. The home to acted independently of the local Adult Protection procedure and not inform Havering’s Adult Protection Co-ordinator or the CSCI of the allegation of rough handling made by a service user to staff. This is poor practice and places service users at risk. The home withheld this information from the inspector who found this by chance. The manager had the opportunity to inform the inspector at the time of the inspection (when the file was picked at random by the inspector) but she chose not to do this. This reflects on the fitness of the registered manager. The CSCI will wait for the outcome of both investigations before making a decision about what legal action may be found necessary to take against the home to protect vulnerable service users. EVIDENCE: There are currently 2 adult protection investigations taking place at the home. One case was raised as a result of a transfer to A & E department of Oldchurch hospital. This was due to the service user condition on admission to the A & E department. The other case was picked up via the inspection process when the inspector chose a file of a service user at random to inspect. An entry in the daily records of the service user for November 2005 stated that the service user had informed staff that she roughly handled and that her hair had been pulled. The home has a complaints procedure and keeps a record of complaints made to the home. There have been 5 complaints recorded since the last inspection Upminster Nursing Home DS0000062200.V270872.R01.S.doc Version 5.0 Page 17 in May 2005. The action taken to investigate these complaints was recorded, however no entry was made as to whether the complainant was happy with the outcome of the complaint. This must be added to the documentation and form part of the investigation process. All of the staff have attended training in the protection of vulnerable adults. This training was put into practice appropriately by the care staff when a service user reported she was roughly handled by a staff member providing personal care. The adult protection procedure was not initiated appropriately by the manager. The manager did not make contact with Havering’s Adult Protection Coordinator, the police, social worker, or the person deemed as next of kin. It is a regulation that the home must also report to the CSCI any misconduct of a staff member. This was not done. The home commenced it’s own investigation and failed to take the appropriate action to protect other service users. Therefore the manager failed in her duty to protect vulnerable service users. This is of grave concern to the Commission. Upminster Nursing Home DS0000062200.V270872.R01.S.doc Version 5.0 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26 The other standards relating to the environment were inspected at the last inspection. Standard 22 relates to specialist equipment of which the home has. However for one service user (who is subject to an adult protection case) this equipment was not provided (pressure relieving mattress). The home in the past has had legal action taken against it for poor pressure care. The manager is failing in her duty to ensure that other health professionals advice is acted upon. This is poor practice. Odour control in 2 bedrooms was poor and this reflects on the dignity of service users. Ongoing decoration is taking place within the home. The external woodwork and walls of the home require maintenance this is an outstanding requirement from the last two inspections that must be dealt with. Upminster Nursing Home DS0000062200.V270872.R01.S.doc Version 5.0 Page 19 EVIDENCE: Since the last inspection the home has provided specialist beds and has the appropriate lifting equipment, pressure relieving mattresses and cushions for use by frail service users. As stated the home has the equipment, but the recommendations made by the Tissue Viability Nurse were not acted upon when this was written as part of her assessment process for one service user. The home in the past has had legal action taken against it in relation to poor pressure care. This is poor practice with the home falling below the required National Minimum Standards. A random selection of service users bedrooms were inspected at 3pm in the afternoon. It was observed that two bedrooms (23 and 24) had a strong odour of stale urine. On investigation it was established that the smell of stale urine was coming from the mattresses of both of the beds. The beds were made up ready for re-use. Any bed where a service user has been incontinent must be cleaned and disinfected with an appropriate cleaning fluid to remove the odour of urine prior to the bed being made up for re-use. Any further failure to ensure that beds are suitable for use will result in formal action being taken against the home by the Commission. Good infection control was observed by the inspector in discussion with the domestic staff member undertaking cleaning as she was able to identify the appropriate infection control procedure for two particular bedrooms. Clinical waste was appropriately stored awaiting collection and the refuse area was clean and tidy. The exterior of the building requires decorating to the woodwork and the rendering. This is has been an outstanding requirement for the last two inspection reports. This must be dealt with to ensure the upkeep of the property and comply with the Regulations. Continued failure to meet requirements made will result in formal action being taken. Upminster Nursing Home DS0000062200.V270872.R01.S.doc Version 5.0 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 and 30 The staffing levels at the home meet the needs of the service users. Employment practice (recruitment and selection) was found to be appropriate when new staff files were inspected at random. Staff training profiles need to be updated to ensure that the current needs of service user are being met appropriately EVIDENCE: Current staffing levels were found to be appropriate on the day of inspection. Since the last inspection several new staff have been employed including an administrator. A random selection of staff files inspected found that the records required by legislation were in place. Although staff training is ongoing and there has been training provided since the last inspection the staff training profiles need to be updated. The manager must ensure that this takes place. Training that has been provided is: Nutritional training for 5 staff on the 27/5/05, Upminster Nursing Home DS0000062200.V270872.R01.S.doc Version 5.0 Page 21 Complaints (updates of policies and procedures - in house training) 26/7/05, Medication training (by Britannia pharmacy) for 6 staff on 27/9/05, Liquid mediation for 3 staff on 29/7/05, First aid for 4 staff on the 3/10/05, Manual Handling for 1 staff on the 3/10/05, Diabetes for 8 staff on the 11/10/05, Wound management for 3 staff on the 29/11/05. Currently staff are undertaking NVQ level 2 training. Two staff are due to finish this course this year. Upminster Nursing Home DS0000062200.V270872.R01.S.doc Version 5.0 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 and 38 Due to the concerns raised about poor care practice, medication records and lack of appropriate action taken by the manager when an allegation of rough handling was reported to her along with the lack of appropriate monitoring by the manager of the home in general. It is evidenced that the home is not being run for the benefit of the service users (standard 33). The manager is failing in her duties to ensure the ongoing care and safety of service users. EVIDENCE: As reported in standards 7, 8, 9, 18, 26 there is a clear lack of management control in relation to the care provided in these standards. Service users finances were inspected it was observed that one service user had 1p less that they should have when the money held in safekeeping was inspected against the records held. Another service users had 1p more that they should have. The home must ensure that all records relating to money Upminster Nursing Home DS0000062200.V270872.R01.S.doc Version 5.0 Page 23 held in safekeeping are appropriately checked for any errors. This is a management responsibility. Health and safety records were inspected the fridge and freezer temperatures were not always being recorded on a daily basis. There was no entries for 19/11/05, 26 & 27/11/05 and the 2 & 3/12/05. The home must ensure that these temperatures are recorded daily. Food was appropriately labelled and dated in the fridge. Melamine cups/mugs were observed to be very scored and stained. The manager stated that an order for new cups had been placed. Confirmation is required to be sent to the CSCI of the date of purchase and that these new cups are in use and that the old cups have been disposed of. The fire records were inspected no fire drill has taken place since November 2004. This was a requirement at the last inspection in May 2005 that fire drills must take place and that all new staff must attend a fire drill. This remains an outstanding requirement. Fire cal points are being tested weekly and a record is kept of this. The fire alarm was service on 1/9/05 along with the emergency lighting system. The fire extinguishers received their annual check on the 3/10/05. A fire risk assessment of the building was undertaken in February and March 2004. The gas safety certificate is fated the 29/11/05 and the portable electrical appliance test was dated 9/5/05. The 5 year electrical safety certificate is dated 2/6/04 and the Legionella test of the water system took place on the 15/11/05 (the home are awaiting there certificate from the water analysis company). The baths hoist and portable hoists were serviced on the 9/8/05. Clinical waste contract was renewed on the 28/8/05. The new collection of unused medications that all nursing home have to comply with took place on the 25/11/05. The nurse call system was serviced on the 24/11/05. The home undertakes checks on the hot water system and this took place on 30/11/05. Wheelchair maintenance took place on the 28/11/05. However one wheelchair in use was very dirty and covered in food debris this needs to be cleaned more often. Upminster Nursing Home DS0000062200.V270872.R01.S.doc Version 5.0 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x x x x X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 1 2 X X 2 X X X 2 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 x x 1 2 x X X 2 Upminster Nursing Home DS0000062200.V270872.R01.S.doc Version 5.0 Page 25 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2 3 Standard OP7 OP7 OP8 Regulation 15(1) 14(2)(a) 13(b) & 12(1)(b) Requirement All care plans must be kept updated as changes occur. This is a re stated requirement. Risk assessment must be correct and be updated as changes occur. The home must be more proactive and see assistance from the Tissue Viability Nurse when wounds are not responding to treatment. A pain chart must be completed for anyone who requires pain control/monitoring. This is a restated requirement. The home must ensure that the appropriate equipment is available to administer insulin to diabetics at all times. The home must review the care of service users more closely and improve the quality of care being provided (wound care & diabetes care). Suitable arrangement must be made for the recording, handling, safekeeping and safe administration and disposal of medication. This is a restated DS0000062200.V270872.R01.S.doc Timescale for action 30/01/05 30/01/06 30/12/05 4 OP8 17(1)(a) sch 3 3(k) 12(1)(a) 30/12/05 30/12/05 5 OP8 6 OP8 24(1)(a) & (b) 30/01/06 7 OP9 13(2) 30/12/05 Upminster Nursing Home Version 5.0 Page 26 8 9 OP12OP OP16 16(2)(n) 17(2) sch4 11 10 OP18 13(6) 11 OP19 23(2)(b) 12 13 14 15 OP26 OP26 OP30 OP33 16(2)(k) 13(3) 19(5)(b) 12(1)(a) 16 17 OP34 OP38 17(2)sche dule 4(9) 23(4)(e) 18 OP38 16(2)(j) requirement. Provide suitable activities for male service users. As part of the recording of complaints the home must state whether the complainant is happy with the outcome of the homes investigation. The adult abuse procedures must be followed by the manager to ensure the safety of vulnerable service users. The external walls must be repaired and painted. The woodwork to windows/doors also requires staining/painting. This is a restated requirement. Ensure the odour of urine is removed from the mattresses in bedroom 23 and 24 Ensure that the melamine cups are kept clean and free from staining at all times. The home must have an up to date training plan for all staff and review staff training needs. The home is not being run appropriately therefore this reflects on the wellbeing of service users. All money held in safekeeping must be correct at all times. Fire drills must take place at regular intervals. All new staff must attend a fire drill. Report in writing to the Commission that this drill has taken place. This is a restated requirement. Ensure the fridge and freezer temperatures are taken and recorded daily. This is a restated requirement. 30/01/06 30/12/05 30/12/05 30/03/06 30/12/05 30/12/05 28/02/06 30/12/06 30/12/05 30/12/05 30/12/05 Upminster Nursing Home DS0000062200.V270872.R01.S.doc Version 5.0 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP19 OP33 Good Practice Recommendations It is recommended that the home keep a record of all refurbishment and decoration. It is recommended that the manager’s and the nursing staff’s performance is monitored more closely. Upminster Nursing Home DS0000062200.V270872.R01.S.doc Version 5.0 Page 28 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford 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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