Inspection on 28/06/06 for Walm Lane Nursing Home

This inspection was carried out on 28th June 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 20 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Walm Lane Nursing Home 17/06/08

Walm Lane Nursing Home 19/06/07

Walm Lane Nursing Home 17/02/06

Walm Lane Nursing Home 29/09/05

Walm Lane Nursing Home 09/03/05

Walm Lane Nursing Home 06/01/05

Similar services:

Ashlong House

Norbury Crescent (30)

Agar Grove & St Augustine`s Alcohol Treatment & Rehab

Henry Nihill House

Birchwood

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

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

CARE HOME ADULTS 18-65 Walm Lane Nursing Home 141 Walm Lane London NW2 3AU Lead Inspector Mr Ram Sooriah Key Unannounced Inspection 28th June 2006 10:00 Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 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 Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Walm Lane Nursing Home Address 141 Walm Lane London NW2 3AU 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) 020 8450 8832 020 8830 7426 Ibexbrook Limited Amanoollah K Juhoor Care Home 21 Category(ies) of Past or present alcohol dependence (0), Past or registration, with number present alcohol dependence over 65 years of of places age (0), Past or present drug dependence (0), Past or present drug dependence over 65 years of age (0), Dementia (0), Dementia - over 65 years of age (0), Learning disability (0), Learning disability over 65 years of age (0), Old age, not falling within any other category (0), Physical disability (0), Physical disability over 65 years of age (0), Sensory impairment (0), Sensory Impairment over 65 years of age (0), Terminally ill (0), Terminally ill over 65 years of age (0) Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to 21 persons over the age of 18 in need of nursing care. Date of last inspection 17th February 2006 Brief Description of the Service: 141 Walm Lane is a nursing home that provides accommodation to 21 adults over 18 years. There were 3 older persons and the rest were young adults at the time of this inspection. The primary care needs of the older adults are nursing and personal care and those of the younger adults are dementia, mental health and alcohol dependency. The home is a large detached building on three floors. It is located close to Cricklewood Broadway and Willesden Green with good access to a variety of shops and local amenities. The home is about 5-10 minutes walk from Willesden Green underground station and is easily accessible by buses which travel down Walm Lane. There is parking for about 2-3 cars in front of the home. Walm Lane and most of the surrounding areas contain resident parking or parking meters. There is also a small area with shrubs and bushes in the front of the home and a large garden at the back of the home accessible to all residents. Accommodation for residents is found on all three floors and a mezzanine floor in seventeen single bedrooms and two double bedrooms. The home currently has 3 bathrooms for the 21 residents. There are 4 bedrooms, no bath and 1 small toilet on the second floor. There has been some addition to the building including a new laundry area, new smoking room with a kitchenette facility and an office. Work was ongoing with regards to converting the sluice/bathroom on the ground floor into a shower room. The home charges £850-£900 for younger adults depending on the needs of the residents and £800 for older people again depending on the needs. At the time of the inspection there was no vacancy in the home. Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on a Wednesday. It started at about 10:00 and finished at about 18:45. Ram Sooriah, the lead inspector, was accompanied on this occasion by Gail Freeman regulation manager. In this report the term ‘inspector’ refers to Ram Sooriah and the term ‘inspectors’ refers to both Ram Sooriah and Gail Freeman. During the course of the inspection, the inspectors were able to look at a sample of records, talk to a number of residents and members of staff. They were also able to engage with Mr Granger, the managing director and Mr Juhoor, the registered manager. The inspector toured some of the premises and looked at some of the catering and laundry arrangements in the home. The inspectors would like to thank all the residents who spoke to them and are grateful to Mr Granger, Mr Juhoor and all his staff for their support and assistance during the inspection. What the service does well: What has improved since the last inspection? There have been some improvements with regard to care records. A newly admitted resident had his needs assessed comprehensively prior to admission by the use of a new format for the pre-admission assessment. A number of other formats have been devised to facilitate the task of completing comprehensive records. Care records are now reviewed at least monthly. These have also been arranged to make them more user friendly and are stored securely in the office. The provision of recreational and leisure activities seems to be more organised. The activities arranged for the day was written on a board for residents to see. Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 6 Some building work has been completed and residents can now benefit from a newly decorated and bright smoking room. The abuse procedure has been reviewed to ensure that it is now more comprehensive. What they could do better: The assessment of the needs of residents in the home and the care records were not comprehensive enough. These must be made more comprehensive and these must also be agreed with residents and/or their relatives. Care plans must be more specific and must contain clear actions that staff need to take to meet the needs of the residents. The registered person must have in place risk assessments to show that the safety of the younger adults accommodated in the home and of others are being taken into consideration while the younger adults are being encouraged to learn new skills, become more independent and be more involved in the local community. Care plans must be clearer with regard to the support that residents need in order to develop new skills and to become more independent. While there is an activities coordinator in the home to do activities with residents, it was noted that there was not much involvement of residents in the local community. The registered person must explore the opportunities available in the local community for residents to take part in, in order to develop new skills and to acquire new knowledge. The three highly dependent older people in the home should be encouraged to use the communal areas and to socialise with other residents in the home where possible and according to the residents’ choices. Whilst the environment is generally suitable for the needs of the residents, residents do not have keys to their bedrooms. Keys should be provided to residents on a risk assessment basis to ensure the promotion of the privacy of residents. The recruitment of new members of staff must be carried out thoroughly and all the records as required by Schedule 2 of the Care Homes Regulations 2001 must be available on file. While training is generally good, the induction of new staff was not always carried out to standards as set out by the Sector Skills Council (Skills for Care). Supervision of staff must take place at least once every two months to ensure that staff members are appropriately supported and that their performance is appropriately monitored. The home must have a quality management system in place to ensure that it is able to monitor the quality of the service that it provides. Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 7 A number of policies and procedures were not available in the home in order to guide staff in performing their duties. As a result the policies and procedures in the home must be reviewed in line with appendix 3 of the National Minimum Standards for care homes. The manager and managing director must ensure that risk assessments are carried out regularly and reviewed in relation to service users who use small kitchen appliances as part of the promotion of their daily living skills. The managing director must ensure that fire risk assessments are carried out annually and that comprehensive records about fire drills are maintained and kept up to date. There must be a more formalised health and safety risk assessment of the home. Records of regular checks of the temperatures of hot water must be kept. With regard to staff who are employed in the home or who are offered employment, the registered person must ensure that all members of staff have the records as per Schedules 2 and 4 of the Care Homes Regulations 2001. Evidence must be kept that these records are in place for each member of staff. There was evidence that one to one supervision of members of staff were taking place but it was not being carried out every two months or six times yearly. More urgency must be given to address requirements identified with regard to health and safety issues. Risk assessments must be in place to address the opening of the sash windows, access of residents to fire exit and to the balcony on the first floor to ensure that residents are not at risk of falling from a height. A number of safety certificates were not available for inspection. These included the electrical wiring certificate, LOLER certificate for the lift and a gas safety certificate. 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. Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service Residents have a pre-admission assessment to determine if the home is able to meet their needs. They then have the opportunity to visit the home to decide if they want to move into the home. EVIDENCE: The inspector looked at the care records of a resident who was recently admitted to the home. The manager had carried out a pre-admission assessment and a copy of that document was kept on file. The new format of the pre-admission assessment devised by the home was used and this was found to contain appropriate information about the needs of the resident. The needs’ assessment of the placing authority was also available for inspection. The inspectors were informed that a copy of the service users’ guide was provided to the new resident and that the latter was given the opportunity to visit the home and to meet members of staff and other residents in the home prior to deciding if he would like to move into the home. The resident was also able to see his prospective room and the facilities that the home had to offer. Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service Care plans have improved but are not yet comprehensive enough. Residents and/or their representatives are not always involved in care planning and formulating risk assessments. A number of risk assessments were not in place, which could be placing residents at risk. EVIDENCE: The care files have been reorganised, tidied and simplified following a recommendation by the CSCI inspectors during the last inspection. The care records were kept in good order and were locked away in drawers in the manager’s office. The care plans of three residents were inspected. It was noted that whilst there has been some improvement in the content of the care records, further improvement was required. The manager explained that work on care plans was ongoing and that together with the deputy manager they planned to further improve the content of the care plans and increase the involvement of the residents in the care planning process. Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 11 Care plans were reviewed monthly and there were records of evaluations of the care plans. Progress with achieving the aims of the care plans and changes in the condition of residents were recorded in the evaluation. Some care plans did not always contain information about the actions that need to be taken to meet the identified needs of residents. The care plan for the management of the Percutaneous Endoscopic Gastrostomy (PEG) tube of a resident mentioned that the PEG site should be kept clean but did not describe how this should be kept clean such as with soap and water or gauze and saline and the frequency that the site should be cleaned. A care plan of a resident for personal hygiene said to give oral hygiene but did not clarify how the oral hygiene was to be provided whether with sponges with mouth care solutions, tooth brushes with toothpaste or with the use of some other accessories. There was no evidence in the care records that residents were involved in drawing up the care plans or in reviewing these. Residents and/or their relatives must be consulted and involved in drawing up and in reviewing the care plans of the residents as far as possible. A note must be made when this is not possible. Residents who were spoken to during the course of the inspection were happy to live in the home. It was noted that residents have the opportunity to make choices about how they wanted to spend their time and about what they wanted to do during the course of the day. Each resident had a key worker. There was however little evidence of interactions/meetings with the resident and key worker to discuss the needs of the residents and to identify areas where the resident may require support and assistance from staff to enhance their independence and to learn new skills, and to evaluate progress that has been made. There were a number of risk assessments in care records such as risk assessment with regard to smoking, use of alcohol and the condition of residents with regard to the use of alcohol such as getting lost due to memory losses brought about by alcohol misuse. There was a care plan in place where a resident is likely to be aggressive and violent. A number of other risk assessments were however not in the care records. The statement of purpose on the first page mentions that ‘If as part of your care plan we are preparing you to return to the community, we will under supervision help you to cook, shop, wash and iron your clothes…..any other assistance you might require such as job hunting, training and finding accommodation’. A conversation with the manager also clarified that it is expected that some of the younger residents would be moving out to the community to live independently at some point. As a result it was expected that formal risk assessments/care plans would be on file about residents’ involvement in activities/processes to enable them build their independence and develop new skills with the longer aim perhaps of Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 12 them moving back into the community to live independently. The care records of two younger adults which were inspected, did not contain plans with regard to developing new skills, promoting the independence of the residents or increasing the involvement of the resident in the local community. A number of residents had ironing boards and irons in their rooms to iron their clothes. A few others had kettles in their rooms. There were no risk assessments on the care records dealing with these. A resident who needed bed rails did not have a risk assessment for the use of this form of restraint. The manager said that he has introduced a new format for a bed rails risk assessment which he plans to put in place. Similarly another resident who was at risk of falls did not have a falls risk assessment and a care plan with control measures in place to manage the risk of falling. Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12-17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service Residents recreational and social needs are not always assessed and addressed in care records. The home provides some leisure and recreational activities for residents. Residents’ rights to privacy and dignity are mostly respected. Residents do not have keys to their bedrooms to ensure that they have all the privacy that they want and within a risk assessment context. Meals provided to residents are generally suited to the needs of the residents. EVIDENCE: A new resident recently admitted to the home had a social assessment of his needs but the other two residents who have been in the home for a while did not have a social assessment. The manager stated that all new residents would have an assessment of their social and recreational needs and that he would cascade this process to existing residents. As mentioned in the previous section, opportunities for development and of learning practical skills were not always identified in care records. There was evidence that the provider has started addressing this aspect of care for Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 14 younger adults by making provision for a kitchenette in the new sitting room/smokers area. The residents could for example get used to tasks such as cooking a microwave meal, making sandwiches and preparing tea and other hot drinks. Apart from activities in the home and from the above input from the home residents were involved in little else whether at college or in the community with regard to acquiring new skills, to manage lifestyles and to increase independence. There was evidence of a recommendation from a healthcare professional about referring a resident to a particular project to manage an aspect of his lifestyle, but there was little evidence that this opportunity was explored. The activities coordinator was not on duty on the day of the inspection but one to one interaction was observed between members of staff and residents. A number of residents were observed in the garden, watching TV, sitting in the smoking room, and others stayed in their rooms according to their wishes. Some residents went out on their own and others needed to be accompanied depending on their risk assessments. There was evidence from care records that residents do receive visitors in the home and that they are also able to visit their relatives/friends according to their individual circumstances. With regard to the three highly dependent elderly residents in the home, activities consisted mostly of one to one interaction. The inspectors were informed that one resident sometimes comes to the lounge but there was little evidence that the other residents also come to the communal areas. One of the residents is confined to his bed. He apparently does not have a suitable chair for him to sit out. It was also not clear if he has been assessed for a chair to suit his needs. The resident whose room is on the second floor at times sits out but in her own room. Residents may very well wish to make the choices to stay in their rooms, but it was not clear if they were being encouraged to come out of their rooms and socialise and if there was appropriate equipment for the residents to be able to sit out and wheeled to the communal areas. As a result of the above the registered person should encourage older residents in the home to sit in the communal areas and to socialise with other residents in the home according to their wishes. He should also review the seating in place for each resident in the home to facilitate this. While one of the aims of the home is to promote the independence of residents, it was noted that residents in the home do not always receive a key to their rooms. The statement of purpose also mentioned that a key is provided to residents. Risk assessments were not available on care records about why keys to the bedrooms were not offered to residents. They also do not get a key to the front door of the home. These are minimum standards to promote residents’ rights and responsibilities (Std 16.2). Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 15 The home has a four weekly menu. There is a chef every day of the week who prepares breakfast and lunch. Suppers are prepared by care staff. The inspector observed staff approaching residents to ask them about their choices for the supper. The choices were recorded. The inspector was informed that residents are also offered choices at lunchtime. According to the manager although the menus contained one choice for lunch, the provision of meals is flexible and other choices are also available to residents. A resident from an ethnic minority stated that he at times receives food to suit his cultural needs. He added that he is also able to visit his relatives where he has meals. The kitchen was clean and tidy. All equipment was working appropriately. The inspector noted that a resident who took pureed meals, was being offered a breakfast cereal with a nutritional supplement for supper. This may well be the choice of the resident. It is recommended that this resident’s diet be reviewed by a dietician/nutritionist Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and part of 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While it was clear that residents receive good personal support from staff, it was not clear if residents nursing and healthcare needs were always met because of the lack of appropriate assessment and care plans addressing the nursing and healthcare needs. EVIDENCE: The inspectors observed that members of staff approached residents and talked to them in an appropriate manner. Personal and nursing care was offered mostly in the bedrooms of the residents or in bathrooms. Residents spoken with were satisfied with the way staff dealt with them and supported them. Residents had varying level of independence and that was taken into consideration when residents were offered choices for example about the clothes that they wanted to wear and about their personal hygiene. The home had a range of equipment to support residents in their care and the home is fully accessible to wheelchair users including the grounds at the back of the home. All residents are registered with a GP. There was also evidence of support from the healthcare professionals from the local PCT. The healthcare and nursing needs of residents varied with some very dependent residents, mostly the elderly residents, and some less dependent ones. Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 17 It was noted that a resident who was epileptic did not have a record when blood was last taken to monitor the serum level of the anti-convulsant medicine. The protocol/care plan with regard to the management of the fit was also not clear. The inspector was informed that the resident is given diazepam when he has a fit. However the care plan did not clarify when the diazepam should be administered, how many times, after how many fits and the situation when the resident should be sent to hospital or referred to the GP. The care plan in place said ‘to use a spoon for the mouth’. This is an out-dated practice that should not be used when people have fits. Residents who were at risk of pressure sores and who were being cared for on pressure relieving equipment did not always have a care plan in place dealing with tissue viability and the pressure relief equipment was not always described in care records. As indicated in the section ‘Individual needs and choices’, a number of risk assessments were not in place to ensure that residents nursing and healthcare needs are being safely met. These must be addressed. A resident who had a ‘percutaneous gastrostomy tube’ (PEG) was having a medicine in the form of a capsule opened and the medicine administered through the tube. In some cases that may be inevitable as some medicines may only be available in a particular format, however in cases where all efforts to find a soluble version of the medicine have failed, clear risk assessments must be in place involving other health professionals such as the GP and the chemist as well as staff from the home and the resident or his/her representative. Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints and allegations and suspicions of abuse are taken seriously in the home. EVIDENCE: Residents receive copies of the complaint procedure in the service users’ guide. There has not been any complaint since the last inspection. The manager stated that he has an open door policy and that residents or their relatives can approach him or his deputy with their concerns. The managing director is also on the premises and it was noted that he was also approachable and that he knew all residents well. There has not been any allegation of abuse in the home. The home has updated the abuse procedure following a requirement from the last inspection. Senior staff in the home were aware of the policy to follow in cases where there are suspicions or allegations of abuse. Residents’ personal money is managed by the managing director of the home. The social benefits and personal money of residents are kept in individual bank accounts. The managing director is also a named person for each individual account to enable him to manage the money on behalf of the residents, who are enable to manage their own affairs. There is a small cash float for each resident from which residents might draw money from or from which personal items can be purchased for each resident. The records with regard to the management of the personal money of two residents were inspected. One resident had taken money out of his cash float, but there was no signature as evidence that the resident had received the money. Inspection of the other Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 19 resident’s accounts and records showed a slight discrepancy which the managing director said he would look into. The personal money of residents is not independently audited. Returns are completed of residents’ personal money for placement authorities. Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service The home is mostly suited to meet the needs of the residents. EVIDENCE: The home is situated close to shops and local amenities. It is easily accessible by public transport and by cars. There is parking for about 2-3 cars in front of the home and there is restricted parking on the roads around the home. The home is a large detached building with a large garden at the back. The home was light and airy and there were no odours in the home. Corridors and communal areas were clean and appropriately furnished. Televisions and sky channels were available for residents’ viewing. The new smoking room/sitting area has been completed and seems to be a comfortable place for smokers to spend their time. Non smokers could sit in the main lounge area. The newly refurbished area also contained a kitchenette area with some facilities for basic cooking. Since this area is in a smokers’ area, it is not clear how non smokers would be able to use that area. The inside of the home was painted in mostly one colour and the managing director stated that residents were given the opportunity to choose the colour and décor of their bedrooms and that no residents chose that opportunity. The Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 21 inspectors that paint chips and marks noted during the last inspection have been rectified. The bedrooms of residents were appropriately furnished and personalised. All rooms have televisions which have been provided by the managing director of the home. Fridges and kettles were also provided to some residents for use in their bedrooms. While it is noted that this is a positive action by the provider, risk assessments were not always present in these cases to ensure the safety of the residents. It was noted that the residents did not have keys to their bedrooms. This would have ensured more privacy to residents, while taking the resident’s risk assessment into consideration. The home has a small laundry area. The laundry area contained a washing machine and a tumble dryer. The area is accessed through doors from the new smoking room. As a result soiled clothes of residents have to be carried through the smokers’ room to the laundry, although staff make sure to bag the clothes appropriately. The laundering of the bed linen is contracted out and only residents’ clothes are washed in the home. The bath and sluice area which used to exist on the ground floor was being converted into a shower area. A new separate sluice area has been created and a steriliser is available. Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had adequate numbers of staff on duty. While training is generally good, induction of new members of staff was not always carried out to the required standard. Recruitment policies and practices were not always carried out thoroughly to ensure the safety of residents. The supervision of nursing and care staff was taking place but not at a frequency of once every two months or six times a year. EVIDENCE: There are two nurses, four care assistants and two ancillary staff on duty in the morning. In the afternoon there is one nurse and four care assistants, at night there is one nurse and one care assistant on duty. An activities person is also employed for the morning shift. It was noted that the home does not have a chef in the afternoon and that care staff were responsible for preparing supper. While care staff are preparing suppers this does take them away from care duties and interactions with residents. They also do the laundry of residents, another not directly related to care duty. Staff confirmed that as a group they tend to support each other and work as a team. They felt that they were supported by management to do a good job, that there was good communication in the home and that they were clear of Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 23 what was expected of them. As a result the experiences of residents living in the home were likely to be positive. Staff spoken with confirmed that before they were employed they had had interviews and that two written references were required. The three staff files inspected included records of enhanced CRB checks and appropriately formatted application forms. Start dates were recorded. One file included a signed and dated terms and conditions of employment but no references. For one recently employed member of staff, although there were two written references on file, it was not clear who they were from. The manager confirmed that achieving written references is part of the recruitment process. A record of the verification of the PIN numbers of trained nurses is maintained. This was kept in the office with medication records. Staff met with said that there was an induction period that comprised shadow working with a more experienced colleague and that this was helpful. Staff files did not contain formal acknowledgement of the induction process. The manager acknowledged that the home did not have a formal staff induction course and checklist. Staff spoken with and staff files confirmed their attendance on relevant training. Staff are confident that training is available for them; this includes NVQ training. Recording of training does not include a formal training and development plan for staff. The manager confirmed that more than 50 of the carers (eleven out of the twelve carers) have an NVQ qualification in care. Staff files inspected included recording of staff supervision and staff spoken with confirmed one to one supervision happens and is useful. However staff and records confirmed that the frequency was about once every six months. The manager added that, now that the deputy manager is in post, supervision frequency will increase. Supervision records inspected included appraisal of staff performance. Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40 and 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The manager runs the home in an open manner. The home has carried satisfaction surveys in the past but not always on a yearly basis. The outcomes of the survey were also not clear as there was no report/action plan. The home did not have a quality management system. The home did not always have comprehensive policies and procedures addressing key areas of practice in the home. A number of health and safety issues were noted which could be putting residents at risk. EVIDENCE: The registered manager has been in post for about four years. He is a trained nurse and he stated that he in the process of doing the Registered Managers’ Award. A new deputy manager has started work in the home to support the manager in securing improvements in the home as required. There was evidence that the manager has arranged residents’ meetings and staff Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 25 meetings. Minutes of the last residents’ meeting of the 6th June were forwarded to the inspector. While some areas of improvement were noted in the home, there were still a number of minimum standards which were not met. The management’s role is to continue to provide strong leadership to ensure that the home will meet all the minimum standards as soon as possible. The inspectors were informed that the home carried out a satisfaction survey in the beginning of 2005. There was however no report or action plan which have been drawn up following the survey. A survey has not yet been carried out for this year. There was no evidence that a quality system operated in the home. There were no audits and no monitoring of the quality of the service based on a quality system. The policies and procedures manual was inspected. It was noted that the manual did not contain a number of policies and procedures as per Appendix 3 of the National Minimum Standards for Younger Adults. [DH, (2001). National Minimum Standards for Younger Adults. The Stationery Office.]. For example there were no policies and procedures on dealing with harassment, emergency and crises, and sexuality and relationship. Staff files inspected and staff spoken with confirmed that staff receive training in manual handling, first aid and fire safety. The cook has achieved certificated food safety training and a number of staff have had training in food hygiene. Safety records and inspection provided evidence that requirements arising from Environmental Health Officer’s last visit re food safety had been attended to by the home. Home safety checks recording included bath and fridge temperatures. The electrical wiring certificate was due for renewal in March 2005. The managing director stated that this was carried out at the time and has made a request to the contractor who carried out the work for a copy of the certificate as the current certificate could not be found. A gas safety certificate for gas appliances in the home was also not available for inspection. It was also noted that a LOLER certificate for the six monthly tests on the lift, as per the Lifting Operations and Lifting Equipment Regulations 1998 (LOLER) was not available for inspection. While touring the premises the inspector noted that the cord for a sash window in a bedroom which was identified, as broken during the last inspection, was still broken. It was also noted that this sash window and a number of others could be opened fully or to such an extent as to allow a person through the gap. Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 26 A room on the 2nd floor has a fire escape door. The resident accommodated in this bedroom or other residents could use this bedroom to gain access to the 2nd floor fire staircase. This is situated at a substantial height and could pose a hazard. Similarly there is a resident who has access to the first floor balcony facing the back of the home. Whilst the inspectors do not wish to restrict the freedom of residents unnecessarily, guidance from the Health and Safety Executive states that: A risk assessment should consider the needs of the service users and look carefully at all foreseeable situations which could give rise to risk. A legal duty is owed to psychiatric and other service users for management to take reasonably practicable steps to minimise the likelihood of service users injuring or killing themselves (HSE, Local Authority Circular, LAC 79/6. 2001. Falls from windows in health and social care settings. Paragraph 15) As a result of the above it is required that these matters are looked at in depth and within a comprehensive risk assessment context. Control measures must be identified as may be necessary to manage any identified risk to residents and others. There was no evidence available that regular health and safety audits are undertaken at the home. Service user files seen included a risk assessment for one service user about aggression with actions identified but it was not dated. Other residents had kettles and irons in their rooms but risk assessments were not seen. The fire risk assessment for the home is dated 2004. The provider stated that this would be up dated. There was evidence of certification of the emergency light system, fire detection system and portable appliances dated 2006. The work sheet included a note of a smoke alarm on the first floor not working in May 06. The managing director stated that this has been attended to. The home’s records included weekly checks of the fire alarm system. Staff records included records of fire safety training for individual staff, and the manager stated that the weekly checking of the system included fire drill. However the names of all people who have taken part in the drills were not recorded. The Fire Officer visited in September 2005 and the managing director stated that all the requirements/recommendations following that inspection have been attended to. Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 3 3 3 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 x 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 x 2 x LIFESTYLES Standard No Score 11 X 12 2 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 3 X 2 2 x 1 x Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 28 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 Standard YA6 Regulation 15(1), (2) 17(1)(a) Requirement Timescale for action 30/09/06 2 YA6 15 3 YA9 13 (4)(c) 13(7) 4 YA9 13(4)c The residents’ plans must be individualised, accurate and up to date, and information contained therein must be consistent. The care plan must fully detail the assessed needs of residents and the action required to meet these needs (Timescale of 30/04/06 not fully met) The registered person must 30/09/06 ensure that care plans and risk assessments are drawn up and agreed with the residents and/or their representatives. That a record is made when this is not possible. Prior to their use, risk 30/09/06 assessments for the use of bedrails must be carried out and the appropriateness of their use clearly identified. This must be discussed and agreed with the service user, their representative or relevant professional. (Timescale of 30/04/06 not fully met) Risk assessments for the 30/09/06 DS0000022945.V301884.R01.S.doc Version 5.2 Page 29 Walm Lane Nursing Home 5 YA9 13(4) prevention of falls must be in place for each resident. (Timescale of 30/04/06 not fully met) The registered person must ensure that care plans and risk assessments address the promotion of the independence of residents, and the development of skills as identified by the assessment of needs while focusing on the safety of the resident and of others through appropriate risk assessments. Risk assessments must be formulated in relation to equipment used by residents in their own bedrooms such as kettles, irons etc. (Repeated requirementtimescale 31/04/06 not met) The registered person must explore the possibility for residents to develop new skills and to identify opportunities for education and learning in the local community according to the individual needs of the resident. That residents’ social and recreational needs are assessed and that care plans are in place to address the individual needs of the residents. The type of pressure relieving and/or moving and handling equipment provided for individual service users must be recorded on their care plan. (Timescale of 31/03/06 not fully met). Residents who are at risk of DS0000022945.V301884.R01.S.doc 30/09/06 6 YA12 16(2)(m) 30/09/06 7 YA14 16(2)(m,n) 30/09/06 8 YA19 13(4)(c)14 30/09/06 Walm Lane Nursing Home Version 5.2 Page 30 9 YA19 14,15 10 YA20 13(2,4) 11 YA34 17(1), sched 2 12 YA35 18(1) 13 YA36 18(2) 14 YA39 24(1) pressure sores must have a care plan in place detailing the actions that need to be taken to manage that risk. The protocols/care plans for residents with epilepsy must be clear about the management of the epileptic fits and individualised to the needs of the resident. That the administration of rectal diazepam is clarified in the protocol/care plan. (Timescale of 31/03/06 not fully met) The registered person must ensure that appropriate risk assessments are in place in cases where medicines are being administered in an altered state and that these have been agreed and signed by the resident and/or representative and relevant healthcare professionals. Staff files must be organised in a way that ensures recruitment process and checks are recorded appropriately and that references are available for inspection. All staff must receive structured induction training according to Sector Skills Council specification. Staff must receive one to one supervision at least six times a year or once every two months. The registered person must establish and maintain a system for evaluating the quality of the services provided in the home. Reports and actions plans must be formulated following satisfaction surveys 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 30/11/06 Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 31 15 YA40 10(1) 16 YA42 13(4) 17 YA42 23(4) 18 YA42 13(4) 19 YA42 13(4) 23(1)(2)(b) The registered person must ensure that the home has policies and procedures according to Appendix 3 of the National Minimum Standards for younger adults and as appropriate to the setting. The registered person must carry out comprehensive risk assessments about the safety of the individual resident occupying the specific location affected and of residents in general with regard to sash windows which could be opened widely (when no window restrainers in place), access to the fire exit door on the second floor (from the bedroom of a resident) and access to the balcony on the first floor. Control measures must be in place where necessary to ensure the safety of residents and others who may have access to these areas. The manager must ensure that comprehensive records are kept about the fire drills in the home, including the names of staff who take part in the drills. The fire risk assessment must be reviewed on a yearly basis. (Repeated requirementtimescale 31/03/06 not fully met) Checks of the hot water temperature must be made regularly and these must be recorded. The managing director/manager must ensure that regular health and safety audits (risk DS0000022945.V301884.R01.S.doc 31/10/06 30/09/06 30/09/06 30/09/06 30/09/06 Walm Lane Nursing Home Version 5.2 Page 32 20 YA42 13(4), 23(2)(c) assessments) take place, it was recommended that the managing director develop a health and safety audit checklist, which is completed periodically, any shortfalls identified and a record kept of action taken to address shortfalls. (Repeated requirementtimescale 31/04/06 not met) Copies of the gas safety 15/09/06 certificate, electrical wiring certificate, LOLER test for the lifts must be available for inspection. Copies of these must be forwarded to the Harrow CSCI office. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA7 Good Practice Recommendations It is recommended that the home keeps evidence of interactions/meetings between the resident and key worker to identify areas where the resident (younger adult) may require support and assistance from staff to enhance his independence and to learn new skills within a risk assessment context. The registered person should encourage the highly dependent older residents in the home to sit in the communal areas and to socialise with other residents in the home according to their wishes. He should also review the seating in place for each resident in the home to facilitate this. That the registered person give serious consideration to residents being offered a key to their bedrooms, which can be locked from the inside and outside, and which can be disabled in emergency. It is recommended that the diet of the resident who has a breakfast cereal for supper be reviewed by a DS0000022945.V301884.R01.S.doc Version 5.2 Page 33 2 OP12 YA14 3 YA16 YA26 4 YA17 Walm Lane Nursing Home 5 YA23 6 YA35 dietician/nutritionist. It is recommended that residents sign the records when they take money out of their personal accounts as evidence that they have received the money. In cases where residents are unable to sign then two members of staff should sign the records. It is recommended that the home has a formal training and development plan for staff. Walm Lane Nursing Home DS0000022945.V301884.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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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