Inspection on 15/04/05 for Verulam House Nursing Home

This inspection was carried out on 15th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Verulam House Nursing Home 06/03/07

Verulam House Nursing Home 24/02/06

Verulam House Nursing Home 21/09/05

Verulam House Nursing Home 29/06/04

Verulam House Nursing Home 25/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

Care Home For Older People Verulam House Nursing Home Verulam Road St Albans Hertfordshire AL3 4DH Unannounced Inspection 15th March 2005 Commission for Social Care Inspection Launched in April 2004, the Commission for Social Care Inspection (CSCI) is the single inspectorate for social care in England. The Commission combines the work formerly done by the Social Services Inspectorate (SSI), the SSI/Audit Commission Joint Review Team and the National Care Standards Commission. The role of CSCI is to: • Promote improvement in social care • Inspect all social care - for adults and children - in the public, private and voluntary sectors • Publish annual reports to Parliament on the performance of social care and on the state of the social care market • Inspect and assess ‘Value for Money’ of council social services • Hold performance statistics on social care • Publish the ‘star ratings’ for council social services • Register and inspect services against national standards • Host the Children’s Rights Director role. Inspection Methods & Findings SECTION B of this report summarises key findings and evidence from this inspection. The following 4-point scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The 4-point scale ranges from: 4 - Standard Exceeded (Commendable) 3 - Standard Met (No Shortfalls) 2 - Standard Almost Met (Minor Shortfalls) 1 - Standard Not Met (Major Shortfalls) O or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable. ESTABLISHMENT INFORMATION Name of establishment Verulam House Nursing Home Address Verulam Road, St Albans, Hertfordshire, AL3 4DH Email address Name of registered provider(s)/company (if applicable) Verulam Health Care Limited Name of registered manager (if applicable) Mrs Annette Gibbons Type of registration Care Home No. of places registered (if applicable) 50 Tel No: 01727 853 991 Fax No: 01727 855 059 Category(ies) of registration, with (number of places) Old age, not falling within any other category (50), Terminally ill over 65 years of age (5) Registration number I020000283 Date first registered 10th November 2003 Was the home registered under the Registered Homes Act 1984? Do additional conditions of registration apply? Date of last inspection Date of latest registration certificate 4th November 2003 YES YES 29/06/04 If Yes refer to Part C Verulam House Nursing Home Page 1 Date of inspection visit Time of inspection visit Name of inspector Name of inspector Name of inspector 1 2 3 15th March 2005 10:00 am Pat House Claire Farrier ID Code 089620 Name of inspector 4 Name of specialist (e.g. Interpreter/Signer) (if applicable) Name of establishment representative at the time of inspection None present Mrs A Gibbons, Registered Manager Verulam House Nursing Home Page 2 CONTENTS Introduction to Report and Inspection Inspection Visits Brief Description of the Services Provided Part A: Summary of Inspection Findings Inspector’s Summary Statutory Requirements/Good Practice Recommendations from last Inspection Conditions of Registration Statutory Requirements/ Good Practice Recommendations from this Inspection Part B: Inspection Methods & Findings National Minimum Standards For Older People: Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management & Administration Part C: Part D: D.1. D.2. D.3. Compliance with Conditions (if applicable) Provider’s Response Provider’s Comments Action Plan Provider’s Agreement Verulam House Nursing Home Page 3 INTRODUCTION TO REPORT AND INSPECTION Every establishment that falls within the jurisdiction of the Commission for Social Care Inspection (CSCI), is subject to inspection, to establish if the establishment is meeting the National Minimum Standards relevant to that setting and the requirements of the Care Standards Act 2000. This document summarises the inspection findings of the CSCI in respect of Verulam House Nursing Home. The inspection findings relate to the National Minimum Standards (NMS) for Care Homes for Older People published by the Secretary of State under the Care Standards Act 2000. The Regulations applicable to the inspected service are secondary legislation, with which a service provider must comply. Service providers are expected to comply fully with the National Minimum Standards. The National Minimum Standards will form the basis for judgements by the CSCI regarding registration, the imposition and variation of registration conditions and any enforcement action. The report follows the format of the NMS and the numbering shown in the report corresponds to that of the Standards. The report will show the following: • Inspection methods used • Key findings and evidence • Overall ratings in relation to the standards • Compliance with the Regulations • Required actions on the part of the provider • Recommended good practice • Summary of the findings • Provider’s response and proposed action plan to address findings This report is a public document. INSPECTION VISITS Inspections are undertaken in line with the agreed regulatory framework with additional visits as required. This is in accordance with the provisions of the Care Standards Act 2000. The report is based on the findings of the specified inspection dates. Verulam House Nursing Home Page 4 BRIEF DESCRIPTION OF THE SERVICES PROVIDED. Verulam House is registered to provide nursing and personal care to older people. It is a Grade 2 listed building situated in the heart of St Albans. The town centre is a few minutes walk away. Parking is provided to the front and side of the building. The building which was formally the Bishop’s Palace has been extended and provides a high standard of accommodation retaining many of the original features. The two main lounges, activities room and dining room are spacious and furnished and decorated in keeping with the period and style of the building. Assisted bathing and toilet facilities are provided. Residents’ rooms are individual in style and have attractive views over either the garden or conservation area of the city. The majority of rooms have en-suite facilities. Verulam House Nursing Home Page 5 PART A SUMMARY OF INSPECTION FINDINGS INSPECTOR’S SUMMARY (This is an overview of the inspector’s findings, which includes good practice, quality issues, areas to be addressed or developed and any other concerns.) Verulam House Nursing Home Page 6 Due to representations made by the proprietors following the last inspection there has been a delay in the publication of that report. There were 41 residents in the home on the day of this inspection. The few requirements from the previous inspection had been actioned. The home was bright, clean and well maintained. The fewer numbers of residents have led to some changes in staff numbers in the home, aspects of these changes were discussed with the inspectors, and are still being reviewed, as described in the report Choice of Home: Standards 1 – 6 5 of these 6 standards were fully assessed and met at the last inspection, so were not examined on this occasion. Standard does 6 not apply to this home. Health & Personal Care: Standards 7 – 11 2 of the 3 standards assessed were met, 2 were fully assessed and met at the last inspection, and were not examined on this occasion. Care plans were examined and tracked after individuals were spoken to by the inspectors. These plans were generally adequate. There were some small errors to do with medication storage and administration. A requirement has therefore been made for Standard 9. Daily Life and Social Activities: Standards 12 – 15 The standard assessed was met, 3 were fully inspected and met at the last inspection, so were not examined on this occasion. Residents confirmed that the home is continuing to provide a wide choice of food, which is of high standard and is freshly made by kitchen staff. Complaints and Protection: Standards 16 – 18 The standard assessed was met, 2 were fully assessed and met at the last inspection, so were not examined on this occasion. Environment: Standards 19-26 Both of the 2 standards assessed were met, 6 were fully assessed and met at the last inspection, so were not examined on this occasion. The home was well maintained, bright and clean on the day of the inspection. The grounds looked very attractive. Residents told the inspectors they were unable to access the main grassed area of the garden, as it has an upward slope and there is no path to walk on or push a wheelchair along. Comments received from the provider following the inspection explain why this is not possible as it is a grade 2 listed building. Staffing: Standards 27 – 30 1 of the 2 standards assessed was met, 2 were fully assessed and met at the last inspection, so were not examined on this occasion. Recruitment records were examined and all checks were in place, including CRB clearance for the two regular hairdressers at the home. Staffing numbers had recently been reassessed at the home after commissioning an independent consultant to ensure dependency levels are safely met. It is acknowledged that change is difficult, however many of the residents and staff expressed that they were unhappy about these changes. The management should continue to consult with these groups, to ensure that high levels of care provision are maintained. It is acknowledged that the current staffing levels are adequate and meet the levels required by the Commission. Verulam House Nursing Home Page 7 Management & Administration: standards 31 – 38 All of the 5 standards assessed were met, 3 were fully assessed and met at the last inspection, so were not examined on this occasion. Since the last inspection, the Manager has completed the Registered Manager’s Award. Questionnaires have been sent to all residents and families as part of the Quality Assurance system. Residents’ care plans are now kept in a locked cupboard, in line with the Data Protection Act. Some amendments to the report were made following correspondence with the provider. A copy of this correspondence is on file at the Area Office. Verulam House Nursing Home Page 8 Requirements from last Inspection visit fully actioned? If No please list below YES STATUTORY REQUIREMENTS Identified below are areas not addressed from the last inspection report, which indicate a non-compliance with the Care Standards Act 2000 and accompanying Regulations. The code in “Standard” is a cross-reference to the Standards described in full in the section “Inspection Findings”. No. Regulation Standard Required actions Timescale for action Action is being taken by the Commission for Social Care Inspection to ensure compliance in regard to the above requirements. RECOMMENDATIONS Identified below are recommendations from the last inspection that have not been implemented No. Refer to Good Practice Recommendations Standard CONDITIONS OF REGISTRATION THAT APPLY (OTHER THAN NUMBERS AND CATEGORY OF SERVICE USERS). Within the overall capacity, this home may accommodate 50 older people who require nursing or convalescent care. Within the overall capacity, this home may accommodate 5 service users between the ages of 55 and 64. Within the overall capacity, this home may accommodate up to 5 service users, 55 years of age or over, who require Terminal Care. Met (Yes / No) YES YES YES Verulam House Nursing Home Page 9 STATUTORY REQUIREMENTS IDENTIFIED DURING THE INSPECTION Action Plan: The Registered Person is requested to provide the Commission with an Action Plan, which indicates how requirements are to be addressed with the time scale within which such actions will be taken. This action plan will be made available on request to the Area Office. STATUTORY REQUIREMENTS Identified below are areas addressed in the main body of the report, which indicate noncompliance with the Care Standards Act 2000, and accompanying Regulations 2001 and the National Minimum Standards. The Registered Provider(s) is/are required to comply within the given time scales. The code in “Standard” is a cross-reference to the Standards described in full in the section “Inspection Findings”. No. Regulation Standard * Requirement Timescale for action The Registered Provider must ensure that all medication is kept safely locked away at all times; all non- blistered medication is dated on opening, with totals carried forward for auditing purposes. 15th March and henceforth 1 13(2) OP9 RECOMMENDATIONS Identified below are areas addressed in the main body of the report, which relate to National Minimum Standards and are seen as good practice issues, which should be considered for implementation by the registered Provider(s). The code in “Standard” is a cross-reference to the Standards described in full in the section “Inspection Findings”. No. Refer to Good Practice Recommendations Standard * The Registered Provider should ensure that service users and staff are consulted and satisfied that the new staffing arrangements are adequate to meet the assessed needs of service users in the home 1 OP27 * Note: You may refer to the relevant standard in the remainder of the report by omitting the 2-letter prefix e.g. OP10 refers to Standard 10. Verulam House Nursing Home Page 10 PART B INSPECTION METHODS & FINDINGS The following inspection methods have been used in the production of this report Direct observation Indirect observation Sampling • Pre-inspection questionnaire • Records • Care plans / Care pathways • Meals • Activities • Other (Specify) ‘Tracking’ care and support Group discussion with service users Individual discussion with service users Group discussion with staff Individual discussion with staff Discussion with management Service user survey Relatives/significant others survey/feedback Visiting professionals survey / feedback Tour of premises Formal interviews Document reading Additional inspection information: Number of service users spoken to at time of inspection Number of relatives/significant others the inspectors had contact with Number of letters received in respect of the service CRB check for the responsible individual seen CRB check for the manager seen Certificate of registration was displayed at the time of the inspection Certificate of registration accurately reflected the situation in the service at the time of inspection Total number of care staff employed (excluding managers) Total number of staff with nursing qualifications employed Date of inspection Time of inspection Duration of inspection (hrs) YES YES NO YES YES YES NO NO YES NO YES NO YES YES NO NO NO YES NO YES 10 1 0 YES YES YES YES 31 X 15/03/05 10.00 10.00 Verulam House Nursing Home Page 11 The following pages summarise the key findings and evidence from this inspection, together with the CSCI assessment of the extent to which the National Minimum Standards for Care homes for older people have been met. The following scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The scale ranges from: 4 - Standard Exceeded 3 - Standard Met 2 - Standard Almost Met 1 - Standard Not Met (Commendable) (No shortfalls) (Minor shortfalls) (Major shortfalls) 0 or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. “X” is used where a percentage value or numerical value is not applicable. Verulam House Nursing Home Page 12 Choice of Home The intended outcomes for the following set of standards are: • • • • • • 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. Standard 1 (1.1 – 1.3) The registered person produces and makes available to service users an up to date statement of purpose setting out the aims, objectives, philosophy of care, services and facilities, and terms and conditions of the home; and provides a service users’ guide to the home for current and prospective residents. The statement of purpose clearly sets out the physical environmental standards met by a home in relation to standards 20.1, 20.4, 21.3, 21.4, 22.2, 22.5, 23.3 and 23.10: a summary of this information appears in the home’s service user’s guide. Range of fees charged From (£) 650 To (£) 900 Any charges for extras If yes, please state what the extra’s are: YES CHIROPODY; TOILETRIES; HAIRDRESSING; OUTINGS 0 Standard met? Key findings/Evidence This standard was not assessed on this occasion. Verulam House Nursing Home Page 13 Standard 2 (2.1 – 2.2) Each service user is provided with a statement of terms and conditions at the point of moving into the home (or contract if purchasing their care privately). 0 Key findings/Evidence Standard met? This standard was not assessed on this occasion. Standard 3 (3.1 – 3.5) New service users are admitted only on the basis of a full assessment undertaken by people trained to do so, and to which the prospective service user, his/her representatives (if any) and relevant professionals have been party. 0 Key findings/Evidence Standard met? This standard was not assessed on this occasion. Standard 4 (4.1 - 4.4) The registered person is able to demonstrate the homes capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. 0 Key findings/Evidence Standard met? This standard was not assessed on this occasion. Standard 5 (5.1 – 5.3) The registered person ensures that prospective service users are invited to visit the home and to move in on a trial basis, before they and / or their representatives make a decision to stay; unplanned admissions are avoided where possible. 0 Key findings/Evidence Standard met? This standard was not assessed on this occasion. Verulam House Nursing Home Page 14 Standard 6 (6.1 - 6.5) Where service users are admitted only for intermediate care, dedicated accommodation is provided together with specialised facilities, equipment and staff, to deliver short term intensive rehabilitation and enable service users to return home. 9 Key findings/Evidence Standard met? This service is not offered at Verulam House. Verulam House Nursing Home Page 15 Health and Personal Care The intended outcomes for the following set of standards are: • • • • • The service user’s health, personal and social care needs are set out in an individual plan of care. Service users make decisions about their lives with assistance as needed. 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. Standard 7 (7.1 – 7.6) A service user plan of care generated from a comprehensive assessment (see Standard 3) is drawn up with each service user and provides the basis for the care to be delivered. 3 Key findings/Evidence Standard met? Care plans are now kept in a locked cupboard in the nurses’ station. Each resident also has a copy of their plan, kept discreetly in their bedroom. Most of the records checked were signed by residents or their family and all contained moving and handling risk assessments. Appropriate details were in place for a resident who administers her own medication. The Manager said that she was considering changing the care plan recording system and the need to increase the range of risk assessment was also discussed with the inspectors. Standard 8 (8.1 – 8.13) The registered person promotes and maintains service users’ health and ensures access to health care services to meet assessed needs. No. of incidents where service users have been taken to Accident and Emergency during last 12 months No. of service users with pressure sores at time of inspection (from information taken from care notes) 2 X 3 Key findings/Evidence Standard met? Accident records were examined and were in order. The records complied with the requirements of the Data Protection Act. Care plans examined showed detailed information of residents’ skin care and incontinence. Service users spoken to confirmed they had access to regular services from chiropodists, opticians and dentists Verulam House Nursing Home Page 16 Standard 9 (9.1 – 9.11) The registered person ensures that there is a policy and staff adhere to the procedures for the receipt, recording, storage, handling administration and disposal of medicines, and service users are able to take responsibility for their own medication if they wish, within a risk management framework. 2 Key findings/Evidence Standard Met? Each floor of the home has its own medication trolley. Medication administration was observed during the inspection. Records of administration were generally good, with no gaps seen on the MAR charts, but not all medication packages were dated on opening. Some totals of medication had not been carried forward on the MAR charts, making auditing difficult. The home has a separate cupboard for controlled drugs, which has a double lock on the door. During the inspection, a store of drugs, which had been due for collection by the pharmacist on the previous evening, was found inside an office door, which was open. There was easy access to these drugs and the inspector asked staff to lock the door. Standard 10 (10.1 – 10.7) The arrangements for health and personal care ensure that service users’ privacy and dignity are respected at all times, and with particular regard to: personal care giving, including nursing, bathing, washing, using the toilet or commode, consultation with, and examination by, health and social care professionals, consultation with legal and financial advisors, maintaining social contacts with relatives and friends, entering bedrooms, toilets and bathrooms, and following death. 0 Key findings/Evidence Standard met? This standard was not assessed on this occasion. Standard 11 (11.1 – 11.12). Care and comfort are given to service users who are dying, their death is handled with dignity and propriety, and their spiritual needs, rites and functions observed. 0 Key findings/Evidence Standard met? This standard was not assessed on this occasion. Verulam House Nursing Home Page 17 Daily Life and Social Activities The intended outcomes for the following set of standards are: • • • • 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. Standard 12 (12.1 – 12.4) The routines of daily living and activities made available are flexible and varied to suit service users’ expectations, preferences and capacities. 0 Key findings/Evidence Standard met? This standard was not assessed on this occasion. Standard 13 (13.1 – 13.6) Service users are able to have visitors at any reasonable time and links with the local community are developed and/or maintained in accordance with service users’ preferences. 0 Key findings/Evidence Standard met? This standard was not assessed on this occasion. Standard 14 (14.1 – 14.5) The registered person conducts the home so as to maximise service users’ capacity to exercise personal autonomy and choice. 0 Key findings/Evidence Standard met? This standard was not assessed on this occasion. Verulam House Nursing Home Page 18 Standard 15 (15.1 – 15.9) The registered person ensures that service users receive a varied, appealing, wholesome and nutritious diet, which is suited to individual, assessed and recorded requirements, and that meals are taken in a congenial setting and at flexible times. 4 Key findings/Evidence Standard met? During the inspection staff were seen recording residents’ choices of food for the following day. Residents told the inspectors that they enjoyed the meals in the home. The mid-day meal was observed and looked appetising and plentiful. It was noted at the last inspection that the variety and standard of food prepared in the home was extremely good and residents confirmed that these standards were continuing. Verulam House Nursing Home Page 19 Complaints and Protection The intended outcomes for the following set of standards are: • • • 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. Standard 16 (16.1 – 16.4) The registered person ensures that there is a simple, clear and accessible complaints procedure, which includes the stages and time-scales for the process, and that complaints are dealt with promptly and effectively. No. of complaints made to the home during last 12 months No. of these complaints fully substantiated No. of these complaints partly substantiated No. of these complaints not substantiated No. of these complaints not yet resolved No. of complaints sent direct to CSCI Percentage of complaints responded to within 28 days 0 X X X X 0 X 3 Key findings/Evidence Standard met? The home has a written complaints policy, which meets the requirements of this standard. Residents spoken to said they would tell one of the staff if they had a concern or a complaint about the home. Verulam House Nursing Home Page 20 Standard 17 (17.1 – 17.3) Service users have their legal rights protected, are enabled to exercise their legal rights directly and participate in the civic process if they wish. 0 Key findings/Evidence Standard met? This standard was not assessed on this occasion. Standard 18 (18.1 – 18.6) The registered person ensures that service users are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self harm, inhuman or degrading treatment, through deliberate intent, negligence or ignorance, in accordance with written policies. The home has an Adult Protection procedure (including Whistle Blowing) which complies with the Public Disclosure Act 1998 and the Department of Health Guidance No Secrets No. of staff referred for inclusion on POVA lists Key findings/Evidence This standard was not assessed on this occasion. Standard met? YES 0 0 Verulam House Nursing Home Page 21 Environment The intended outcomes for the following set of standards are: • • • • • • • • 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. Standard 19 (19.1 – 19.6) The location and layout of the home is suitable for its stated purpose; it is accessible, safe and well maintained; meets service users’ individual and collective needs in a comfortable and homely way and has been designed with reference to relevant guidance. 3 Key findings/Evidence Standard met? The home was bright, clean and in good decorative order on the day of the inspection. A new fire door has been fitted in the kitchen area, and a new call alarm system has been fitted around the home. The work to re-furbish a shower room is continuing, and the Manager is aware that the top floor bath has several chips and scratches and needs some attention. The gardens looked very well kept and attractive. Standard 20. (20.1 – 20.7) In all newly built homes and first time registrations the home provides sitting, recreational and dining space (referred to collectively as communal space) apart from service users’ private accommodation and excluding corridors and entrance hall amounting to at least 4.1 sq. metres for each service user. 3 Key findings/Evidence Standard met? There are a range of communal rooms where service users can sit or entertain visitors and where group activities can take place. There are two dining rooms and a large attractive garden with two patio areas. Furnishings are of good quality. There is good lighting throughout the home. However several residents said that they were disappointed that they were unable to access the main garden area, except the patios, as there were no paths across the grass, also access was restricted because the ground sloped upwards away from the house. Residents said that when visitors arrived in good weather, the patios became very crowded, and it was difficult to speak to families privately and that because there were no paths, wheel chairs could not be pushed across the grass. The home is a grade 2 listed building and alterations are not feasible and the proprietors state would detract from the attractiveness of the gardens. The proprietors further state that there is ample space for service users and visitors in the garden and the garden/patio areas are not too crowded. Verulam House Nursing Home Page 22 Standard 21 (21.1 – 21.8) Toilet, washing and bathing facilities are provided to meet the needs of service users. 0 Key findings/Evidence Standard met? This standard was not assessed on this occasion. Standard 22 (22.1 – 22.8) The registered person demonstrates that an assessment of the premises and facilities has been made by suitably qualified persons, including a qualified occupational therapist, with specialist knowledge of the client groups catered for, and provides evidence that the recommended disability equipment has been secured or provided and environmental adaptations made to meet the needs of service users. 0 Key findings/Evidence Standard met? This standard was not assessed on this occasion. Verulam House Nursing Home Page 23 Standard 23 (23.1 – 23.11) The home provides accommodation for each service user which meets minimum space as prescribed Total number of single bedrooms with at least 10 sq.m usable space or additional compensatory space Pre-existing homes only (1 April 2003) - single bedrooms below 10 sq.m usable space or additional compensatory space Total number of wheelchair users accommodated for in rooms at least 12sq.m Total number of wheelchair users accommodated for in rooms at less than 12sq.m Total number of shared rooms at least 16 sq.m Total number shared rooms less than 16 sq.m Percentage of places within single rooms: 100 80 - 99 Less than 80 Total number of single bedrooms Total number of single rooms with en suite Total number of double rooms Total number of double rooms with en suite Key findings/Evidence This standard was not assessed on this occasion. NO YES NO 44 42 3 3 Standard met? 0 44 0 X X 1 0 Verulam House Nursing Home Page 24 Standard 24 (24.1 – 24.8) The home provides private accommodation for each service user which is furnished and equipped to assure comfort and privacy, and meets the assessed needs of the service user. 0 Key findings/Evidence Standard met? This standard was not assessed on this occasion. Standard 25 (25.1 – 25 8) The heating, lighting, water supply and ventilation of service users’ accommodation meet the relevant environmental health and safety requirements and the needs of individual service users. 0 Key findings/Evidence Standard met? This standard was not assessed on this occasion. Standard 26 (26.1 – 26.9) The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection, in accordance with relevant legislation and published professional guidance. 0 Key findings/Evidence Standard met? This standard was not assessed on this occasion. Verulam House Nursing Home Page 25 Staffing The intended outcomes for the following set of standards are: • • • • 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. Standard 27 (27.1 – 27.7) Staffing numbers and skill mix of qualified/unqualified staff are appropriate to the assessed need of the service users, the size, the layout and purpose of the home, at all times. Number of staff /hours in respect of service user needs based on guidance recommended by Department of Health. Personal Nursing Care No. service users High No. staff hours X X X needs allocated No. service users Medium needs No. service users Low needs No. of staff hours required No. of full time equivalent first level registered nurses No. of care staff No. of ancillary staff X X X No. staff hours allocated No. staff hours allocated No. of staff hours provided X X X X X X X X X Verulam House Nursing Home Page 26 2 Key findings/Evidence Standard met? During the inspection, almost all the residents and staff spoken to commented to the inspectors about the changes recently made to the staffing numbers in the home. There were fewer residents in the home at the time of the inspection. The Manager said that an independent consultant had been commissioned to base staffing levels to meet dependency levels. The aim was to exclude the use of agency staff so that continuity of care can be met. However, those spoken to felt that good standards of care could not be maintained with the current reduced staff numbers. Residents said that they now waited longer for call alarms to be answered, some said they had a long wait for the commode and for assistance with feeding. Two residents who needed high levels of assistance said they had to wait a long time to get up and to be put to bed. Some staff said they no longer had time to provide the extra help to residents, such as cutting nails and spending time in conversation. During the inspection, it was noted that a small number of the residents were not dressed at 11.15 a.m. and were waiting for staff to assist them. The Manager said that ten care staff, including two or three nurses, were now on duty in the mornings, with at least eight in the afternoon and five at night. There had been one staff meeting where issues had been discussed and another was due the following week. Residents confirmed that they had been told about the staff reductions at a meeting. It is acknowledged that all changes to routines can be difficult to accept at first, but the Manager must ensure that staffing levels are adequate to maintain the high levels of care normally provided at the home, and that residents are clear about how their care will be provided and are able to discuss any areas of concerns about staffing on a regular basis. A recommendation has been made. Standard 28 (28.1 – 28.3) A minimum ratio of 50 trained members of care staff (NVQ Level 2 or equivalent) is achieved by 2005, excluding the registered manager and/or care manager, and in care homes providing nursing, excluding those members of the care staff who are registered nurses. No. care staff (excluding registered nurses) with NVQ level 2 or equivalent of care staff with NVQ level 2 Key findings/Evidence This standard was not assessed on this occasion. X X Standard met? 0 Verulam House Nursing Home Page 27 Standard 29 (29.1 – 29.6) The registered person operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. 3 Key findings/Evidence Standard met? A selection of recruitment files were checked during the inspection and all appropriate checks were in place. The two regular hairdressers now have CRB clearance. Standard 30 (30.1 – 30.4) The registered person ensures that there is a staff training and development programme which meets the National Training Organisation (NTO) workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. 0 Key findings/Evidence Standard met? This standard was not assessed on this occasion. Verulam House Nursing Home Page 28 Management and Administration The intended outcomes for the following set of standards are: • • • • • • • • 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. Standard 31 (31.1 – 31.8) The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. 3 Key findings/Evidence Standard met? The Manager is a registered nurse has been managing Verulam House since 1997. The Manager has completed the Registered Manager’s Award since the last inspection. The Director of Nursing is responsible for training. The manager is supported by two deputy managers who divide their responsibilities between the day and night staff. Generally staff seemed very clear about their roles in the home and said there were good working relations with the two directors of the home, whose offices are on-site. Standard 32 (32.1 – 32.7) The registered manager ensures that the management approach of the home creates an open, positive and inclusive atmosphere. 0 Key findings/Evidence Standard met? This standard was not assessed on this occasion. Verulam House Nursing Home Page 29 Standard 33 (33.1 – 33.10) Effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in meeting the aims, objectives and the statement of purpose of the home. 3 Key findings/Evidence Standard met? The manager has recently sent questionnaires to all service users and families. Residents showed these to the inspectors. They also confirmed they have regular residents’ meetings, which are minuted. The manager monitors the returned questionnaires and the inspector saw the self-audit file, which covers all aspects of the home and includes the assessment of outcomes from quality monitoring systems. Standard 34 (34.1 – 34.5) Suitable accounting and financial procedures are adopted to demonstrate current financial viability and to ensure there is effective and efficient management of the business. 3 Key findings/Evidence Standard met? Certificates of appropriate insurance cover were seen displayed in the home, during the inspection. The Manager has no allocated budget for the home, as the Proprietors have offices in the home and manage all budgets in consultation with the Manager. The Proprietor has, since the inspection, forwarded a thorough business plan for the home, to the Commission and this standard has been met. Standard 35 (35.1 – 35.6) The registered manager ensures that service users control their own money except where they state that they do not wish to or they lack capacity and that safeguards are in place to protect the interests of the service user. Number of service users subject to Power of Attorney processes Number of service users subject to Enduring Power of Attorney processes Number of service users subject to Guardianship Orders Key findings/Evidence This standard was not assessed on this occasion. Standard met? 0 X X X Verulam House Nursing Home Page 30 Standard 36 (36.1 – 36.5) The registered person ensures that the employment policies and procedures adopted by the home and its induction, training and supervision arrangements are put into practice. 0 Key findings/Evidence Standard met? This standard was not assessed on this occasion. Standard 37 (37.1 – 37.3) Records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. 3 Key findings/Evidence Standard met? Care plans and residents’ information are now kept locked in a cupboard at the nurses’ station. The manager said that service users could have access to their records at any time, subject to the Data Protection Act. Records examined were generally well kept and up to date. Standard 38 (38.1 – 38.9) The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. 3 Key findings/Evidence Standard met? The accident and fire records were checked during the inspection. The electric wiring certificate was also seen. The CSCI receive regular information from the home about incidents affecting service users. Hot water temperatures were checked in bathrooms during the inspection. The top floor bathroom and most of the others had hot water being delivered within safe limits. The water temperature in the second floor bathroom was slightly high, but the manager said that this varied and confirmed that temperature checks are completed all around the home. During the mid-day meal, staff were seen carrying food from the kitchen to the small dining room, the inspectors therefore advised the Manager to complete a risk assessment for staff safety for this procedure. The Manager also said that the home would be purchasing a heated trolley so that staff could transfer meals safely and to ensure that food stays hot. Verulam House Nursing Home Page 31 PART C (where applicable) COMPLIANCE WITH CONDITIONS YES Condition Compliance Within the overall capacity, this home may accommodate 50 older people who require nursing or convalescent care. Comments YES Condition Compliance Within the overall capacity, this home may accommodate 5 service users between the ages of 55 and 64. Comments YES Condition Compliance Within the overall capacity, this home may accommodate up to 5 service users, 55 years of age or over, who require Terminal Care. Comments Lead Inspector Second Inspector Date Pat House Claire Farrier 30 June 2005 Signature Signature Signature Regulation Manager Helen Pettengell Public reports It should be noted that all CSCI inspection reports are public documents. Verulam House Nursing Home Page 32 PART D D.1 PROVIDER’S RESPONSE TO IDENTIFIED STATUTORY REQUIREMENTS Registered Person’s comments/confirmation relating to the content and accuracy of the report for the above inspection. We would welcome comments on the content of this report relating to the Inspection conducted on 15th March 2005 and any factual inaccuracies: Please limit your comments to one side of A4 if possible Verulam House Nursing Home Page 33 Action taken by the CSCI in response to provider comments: Amendments to the report were necessary YES Comments were received from the provider Provider comments/factual amendments were incorporated into the final inspection report Provider comments are available on file at the Area Office but have not been incorporated into the final inspection report. The inspector believes the report to now be factually accurate YES YES YES Note: In instances where there is a major difference of view between the Inspector and the Registered Provider both views will be made available on request to the Area Office. Please provide the Commission with a written Action Plan by 29th April 2005, which indicates how requirements are to be addressed and stating a clear timescale for completion. This will be kept on file and made available on request. You will also note that the Commission has identified in the inspection report good practice recommendations and it would be useful to have some indication as to whether you intend to take any action to progress these. D.2 Status of the Provider’s Action Plan at time of publication of the final inspection report: Action plan was required Action plan was received at the point of publication Action plan covers all the statutory requirements in a timely fashion Action plan did not cover all the statutory requirements and required further discussion Provider has declined to provide an action plan Other: enter details here Verulam House Nursing Home Page 34 D.3 PROVIDER’S AGREEMENT Registered Person’s statement of agreement/comments: Please complete the relevant section that applies. D.3.1 I Dr D P Tominey MBBS of Verulam House Nursing Home, confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) and that I agree with the requirements made and will seek to comply with these. Print Name Signature Designation Date Or D.3.2 I of am unable to confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) for the following reasons: Dr D P Tominey MBBS Dr D P Tominey MBBS Medical and Managing Director 30th June 2005 Print Name Signature Designation Date Note: In instance where there is a profound difference of view between the Inspector and the Registered Provider both views will be reported. Please attach any extra pages, as applicable. Verulam House Nursing Home Page 35 Verulam House Nursing Home / 15th March 2005 Commission for Social Care Inspection 33 Greycoat Street London SW1P 2QF Telephone: 020 7979 2000 Fax: 020 7979 2111 National Enquiry Line: 0845 015 0120 www.csci.org.uk S0000019601.V216485.R01 © This report may only be used in its entirety. 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