Inspection on 22/08/07 for Woodland Hall

This inspection was carried out on 22nd August 2007.

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 but made no statutory requirements on the home.

Other inspections for this house

Woodland Hall 04/07/06

Woodland Hall 07/02/06

Woodland Hall 13/10/05

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

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

CARE HOMES FOR OLDER PEOPLE Woodland Hall Woodland Hall Clamp Hill Stanmore Middlesex HA7 3BG Lead Inspector Clive Heidrich Key Unannounced Inspection 22nd August 2007 08:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000063588.V342943.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000063588.V342943.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodland Hall Address Woodland Hall Clamp Hill Stanmore Middlesex HA7 3BG 020 8954 7720 020 8954 5582 manager.woodlandhall@careuk.com 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) Care UK Nirmala Kumaree Juggapah Care Home 72 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (55), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (12) DS0000063588.V342943.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th July 2006 Brief Description of the Service: Woodland Hall is a continuing care/respite facility that is owned and managed by Care UK. It had been registered as an independent hospital since it opened in 1995, but voluntarily changed its registration to that of a care home with nursing during the summer of 2005. Woodland Hall is a purpose-built, two-storey building that is currently registered to accommodate 72 patients aged 65 years and older, 5 of whom may have both dementia and be 59 years or over. The service provided is contracted to Harrow Primary Care Trust. The home is located in attractive and peaceful grounds in-between Harrow Weald and Stanmore. It is reasonably close to a few local shops and facilities. Ample parking is available in the front of the hospital. All bedrooms are single rooms with en-suite toilet and washbasin facilities. There are numerous communal toilets and bathing facilities on the wards although the latter are kept locked at all times unless requested for use. Laundry and catering services are located centrally on the site. Woodland Hall is divided into six separate units and there are two respite beds: Greenview Unit (1) - accommodates 12 female residents. Bluebell Unit (2) - accommodates 12 female residents. Cedar Unit (3) - accommodates 12 female residents. Parkview Unit (4) - accommodates 12 female residents. Sunshine Unit (5) - accommodates 12 male residents. Hillside Unit (6) - accommodates 12 male residents. There were 5 vacancies at the time of the inspection. A copy of the Service User Guide is available on request, and also in the entrance hall. DS0000063588.V342943.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The manager kindly provided the CSCI with a detailed Annual QualityAssurance Assessment (AQAA) document in advance of this unannounced inspection. Surveys were then sent to the manager to distribute. These were distributed to residents, relatives/advocates and community professionals. However, relatives/advocates sometimes received surveys meant for other groups such as GPs. Consequently, whilst a very helpful overall response of 29 relatives/advocates and of four health professionals was received by the CSCI, it is noted for references that relatives/advocates answered different sets of questions depending on which survey they received. Their feedback has been used throughout this report. There were no resident surveys returned despite distribution to the home. The inspectors discussed care with some residents during the inspection, however it was often very difficult to acquire resident comments due to the nature of most residents’ health needs. The inspection itself took place across one full day in late August. Another inspector, Mr Sooriah, accompanied the lead inspector. The lead inspector then met with the manager for a few hours, a few days later, to provide feedback, because the manager was on leave during the first day. The first day included discussions with relatives, residents, and staff, a tour of the premises, observations of care practices, and consideration of records. As part of the methodology one of the inspectors spent about two hours observing the care that residents received and the interaction of members of staff with residents, on one unit, to gain information about what is like to live in the home. The inspectors thank all involved in the home for the patience and helpfulness before, during, and after the inspection. What the service does well: The home provides residents/representatives with the appropriate information for them to make an informed decision if they want to live in the home. All residents’ needs are assessed by the manager or her deputy to ensure that the home only admits people that can be cared for in the home. The home is able to demonstrate that the needs of resident are met to a generally good standard. The main asset of the home is the calibre of its staff, who are sensitive and competent to care for people with mental health and dementia care needs. Surveys from relatives/visitors confirmed that they are DS0000063588.V342943.R01.S.doc Version 5.2 Page 6 in the main pleased with the support that the residents receive from staff in their daily lives. There was significant praise from relatives and professionals about staff responsiveness. For instance, one relative noted that, “If the person asked can’t answer, they find someone who can.” Residents have dementia care needs but are still able to take part in a range of social and recreational activities, which engage and stimulate them. They are involved in the daily life of the home and take part in the community according to their wishes and level of risk. The home provides a good standard of responding to complaints. Feedback found very strong levels of complainant satisfaction within responses, and records showed clear actions in responses taken to address complaint issues. Standards of cleanliness are suitably kept across the home in general. Money that is looked after by the home on behalf of residents continues be kept securely and suitably documented about. The home benefits from a motivated and person-centred manager who has suitable experience. What has improved since the last inspection? The needs assessment of individual residents was on the whole comprehensive and addresses all the needs of individual residents. The care plan for manual handling and the risk assessment for manual handling have been updated to include all the action that need to be taken to address the various manual handling manoeuvres required to move residents. Residents have a continence assessment and the care plans contain details about promoting continence and managing the incontinence. The time of the medicines’ rounds in the home have been reviewed to ensure that residents receive their medicines at regular intervals, but the times to administer individual medicines must still be reviewed to ensure that residents receive these at regular intervals. There are now a number of activities arranged in the community which residents can partake of, for instance a recent canal-boat trip. Good attention is paid to the leisure and stimulation needs of residents through activity provision. The menus have been reviewed and these are now much more comprehensive to ensure fully balanced meals for residents. DS0000063588.V342943.R01.S.doc Version 5.2 Page 7 Some equipment has been replaced or upgraded. There are now more adjustable beds for residents to sleep on, new mobile hoists have been purchased, and the home’s phone system has been upgraded, for instance. Recruitment practices now sufficiently safeguard residents. Proper checks of Criminal Records Bureau disclosures and written references are undertaken. Whilst not fully meeting NVQ ratios for care staff, the home has undertaken reasonable actions to ensure that this will be addressed in due course, and hence that the care staff team will be suitably knowledgeable. Further training has also been provided in a number of areas, for instance in dementia care, infection control, and emergency first aid. Quality audits are now being undertaken regularly, including consideration of the views of people involved in the home. What they could do better: The service user guide must be updated to ensure that it contains all the information to enable people make an informed decision about moving into a home, such as information about the range of fees charged by the home, what these cover and the philosophy of care regarding the provision of dementia care. The needs of residents and residents’ care must be kept suitably up-to-date within care plans and risk assessments, to enable a carer or nurse reading the records provide appropriate care to the residents. The provision and the standard of oral hygiene in the home must be reviewed to ensure that residents receive a high standard of oral hygiene, as there lacked evidence of suitable overall support for residents in respect of toothbrushing. Records must be kept about the visit by the dentist as evidence that residents are seen by the dentist at least annually. Residents must also be shaved according to their choices and preferences, to ensure a high standard of personal hygiene. Some residents lacked evidence of having been recently shaved. The time for the administration of some medicines such as antibiotics and painkillers must be reviewed, for residents to benefit fully from these medicines as currently some are going for about 16 hours of the day without any of the medicines. The amount of all medicines received in the home must be recorded and the instructions for the administration of creams and topical medicines must be clear about the location to administer the medicines. Systems must also be set up to ensure that medicines are administered as prescribed, as an ongoing case of a missed daily third dose for one resident was found by the inspectors. There was a recorded case of one resident hitting another, causing injury, which although addressed within the home had not been reported to social DS0000063588.V342943.R01.S.doc Version 5.2 Page 8 services as required under Harrow’s Safeguarding Adults procedure for independent consideration. Management must ensure that any similar scenarios are suitably reported. There is one key outstanding requirement, about renewal of furnishings including carpets. Many areas of the home have signs of wear and tear, as fedback by some relatives to the inspectors. Management note that a budget to address this has now been acquired, so actions to address the issues should now take place promptly. Work needs to take place to better enable disorientated residents to recognise key areas of the home for them. Corridors and bedroom doors for instance are too similar in appearance. Environments that help such residents recognise their surroundings are required. A full list of requirements and recommendations is made at the back of this report. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000063588.V342943.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000063588.V342943.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1-4 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ needs are assessed by the home prior to them being offered a place in the home, to ensure that the home will be suitable for them. Residents and their relatives receive sufficient information to decide if they want to live in the home, but the service users’ guide would be more comprehensive if it contains information about the fees charged by the home and its philosophy with regards to the provision of dementia care. EVIDENCE: All residents who are admitted to the home receive the home’s contract/statement of terms and conditions. The care records of three residents were inspected at random. It was noted that they all contained a copy of the contract/statement of terms and conditions, which were individually signed by the manager/member of staff and resident/representative as required. These documents were comprehensive. As DS0000063588.V342943.R01.S.doc Version 5.2 Page 11 a result residents/representatives received information about their rights and obligations while the resident live in the home. The care records of six residents were inspected. The home’s records are held on computer and managed by a computer system called ‘Saturn 2’. There are hard copies of some of the records and records by other organisations are kept in a hard format in a file. It was noted that all residents’ records contained a pre-admission assessment of needs. These are normally carried out by the manager or by the deputy manager. Copies of the needs assessment of the placing authority were also available on file. It was noted that the format did not contain a section for the assessment of the dementia care needs/mental health needs of residents, but the manager/deputy manager were aware of the need to collect information about the mental health needs of the residents, which they recorded on an additional page. The home has the facilities, and members of staff are knowledgeable and competent enough, to meet the needs of the residents that the home accommodates. The home is purpose built and is reasonably equipped to accommodate the residents. Observation of the residents and the interaction of staff with residents confirm the ability of staff to care for the residents. All interactions and engagements with residents were noted as appropriate. Staff in the home are closely supported by a team of healthcare professionals to meet the needs of the residents. The team includes the GP, psychiatrists, psychologists, dietician, chiropodist, tissue viability nurse, and dentist. Multidisciplinary review meetings are held at least annually, to make sure that the needs of the residents are being met in the home. The needs of residents from ethnic minorities were on the whole addressed in care records. There was evidence that staff in the home make an effort to address these needs. For example, culturally-appropriate food is provided to residents according to their backgrounds, and they are supported by religious leaders who visit the home in order to maintain their religious identity. Surveys from relatives suggest that the majority (6 out of 10) think that the home always meets the needs of the residents. All think that the home, always or usually, gives the support that has been agreed and expected to residents. A range of comments was provided to illustrate this: “Probably the best care home in the area for dementia. Very caring on the whole.” “Looks after elderly, awkward men and women with patience and humour…”. “They provide good care…”. “Total care is very good but most important, it is carried out in a caring and kind way.” “Shows sympathy, listens carefully, and explains as well as possible”. DS0000063588.V342943.R01.S.doc Version 5.2 Page 12 It was noted that the service users’ guide (SUG) does not yet contain information about the range of fees charged by the home as per Regulation 5(bb) of the Care Homes Regulations 2001 (Amended). Residents referred to this home are mostly publicly funded either by the Local PCT or by Local Authorities. The Regulations however do not make allowances for homes that mostly accommodate residents who are publicly funded. Therefore it is still required that the information about fees and the services that are covered by the fees be addressed in the SUG. The SUG does not also make reference to its philosophy of care with regards to the provision of dementia care and the home’s approach with regards to the provision of this service. The manager stated that she will address this issue in the documents mentioned above. The aim of the service is to enable independent living, maintain and improve the current abilities of residents and the promotion of individual care. DS0000063588.V342943.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All of them. People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. There has been an improvement in the standard of care records but these are not always kept updated as and when the needs of residents changed to ensure that the needs of residents would be continuously met. The healthcare needs of residents are on the whole met, but some aspects of the care of residents were found to be lacking. A few issues were noted with the management of medicines which might compromise the safety of residents. Residents’ wishes and instructions about end of life care and funeral arrangements are addressed in care records to make sure that these would be met. DS0000063588.V342943.R01.S.doc Version 5.2 Page 14 EVIDENCE: The care records of six residents held on the computer were inspected as well as some of the hard records kept on file. On the whole records were appropriate but could have been more comprehensive and updated to contain information to meet all the needs of residents. In one case the Waterlow score and the pressure relief equipment in use had been changed, but this was not reflected in the care plan. Two residents on antibiotics did not have care plans addressing the management of their condition. A resident was observed having breathing difficulty at times, secretion in the mouth, and also some swallowing impairment. A care plan was not in place to address the management of this need. Falls risk assessments were in place for residents, and care plans were drawn up when residents were at high risk of falls. However on a few occasions the overall score was not identified on the format for the falls risk assessment and it was therefore not always clear what level of risk the resident faced with regards to falls. Continence assessment and nutritional risk assessments were also completed. It was noted that the nutritional assessments (either the previous nutritional risk assessment tool or the ‘MUST’ tool) for a number of residents were not reviewed monthly. These were reviewed two monthly. There was however evidence that those residents, who were particularly at risk of malnutrition/loosing weight, were referred to the visiting dietician. The manager stated that the dietician then monitored the nutritional intake of the residents at risk and made recommendations if necessary to maintain and improve the nutritional status of residents. Care plans dealt with the aggressive and challenging behaviour of residents. The management or action to take to manage the behaviour was on the whole identified. One resident who did not like to wear her slippers had a care plan in place and another resident who has a habit of going into other residents’ rooms also had a risk assessment in place. In the latter case, little gates were used in front of some other residents’ bedrooms to prevent this. While a risk assessment was present in the resident’s care records, one was not available for other residents who were faced with having a gate in front of their door, and hence there was no evidence of consultation with relevant people such as the resident, next-of-kin, and relevant health professionals. As this could be viewed as a form of restraint, appropriate risk assessment, based on relevant consultations, must also be in place for residents who are faced with having a gate in front of their room. Care plans were reviewed with the relatives/representatives of residents during review meetings, held with the consultant psychologist, funding authority and DS0000063588.V342943.R01.S.doc Version 5.2 Page 15 members of staff. Management noted that changes in the condition of residents are reported to residents’ representatives as required. Feedback from relatives suggested that they are involved and consulted about the care of residents. The manager stated that care plans are printed out for residents’ representatives to take away. They can come back for more information as needed. There is a list of all the needs of residents for residents/representatives to sign to show that they have agreed to them. It was noted that care plans contained information about the cultural and social backgrounds of residents. One survey stated, “the diet and religion of my husband have been catered for.” Residents presented as appropriately dressed and clean. A number of male residents were not shaved on one of the units. The inspectors were informed that a few of the residents did not have razors and that others were waiting for an electric razor to be provided for them. Observation of residents in one of the lounges showed that staff engaged residents in an appropriate manner at all times. Some of the residents were also encouraged to engage with objects such as when a number of music instruments were brought in for residents. It was noted that this stimulated and distracted a few of them. Observation of one resident showed that he was asleep for most of the time of the observation. It is recommended that the care of residents who are excessively sleepy be reviewed to make sure that this is not caused by something which can be resolved. Residents were free to walk between the units, but some of them were under close observation for their own safety. Observations were recorded every 15 minutes by members of staff. Residents’ healthcare needs are met by a range of healthcare professionals. Surveys showed that relatives and visitors to the home were pleased with the physical care of residents. Survey respondents were also pleased with the level of healthcare provided to residents, except for one who felt that the dentist does not visit that regularly. It was difficult to verify if the dentist visited yearly to review the residents, due to a lack of records keeping in this area. There was some evidence that some residents were seen by the dentist as they had been prescribed the oral sprays. A survey mentioned that residents’ teeth are not always brushed. Out of four residents checked by one of the inspectors, none of them have had their teeth brushed that morning. The inspector was informed that the residents use mouth sprays as one of the measures to maintain oral care, as the residents were at the time resistive to oral care provided by care staff. The care records however did not reflect that residents were resistive to that type of care provision, nor the fact that the mouth sprays were in use as part of the oral care. The oral sprays are good for oral care but are no substitute for brushing the teeth. DS0000063588.V342943.R01.S.doc Version 5.2 Page 16 Three residents had pressure ulcers in the home at the time of the inspection. Records were comprehensive and included photographs and regular wound progress notes. The records showed that the residents were regularly seen by the tissue viability nurse for advice and support in managing the ulcers, and that the pressure ulcers were managed appropriately. Care plans of residents also contained information about the pressure relief equipment in use to provide pressure area care. Medicines management was inspected in houses 2/3 and 5/6. The medicines charts and the storage of medicines were inspected. The standard was generally good, but with a few issues that needed addressing. The amounts received of a few medicines were not recorded. The instructions for the administration of a few topical medicines were not always clear. A medicine that should have been given three times a day was given only twice for a week. It was noted that the medicine times have been reviewed. However some medicines including antibiotics and painkillers were given at 0900, 1300 and 1700. This means that the residents on those medicines were not getting the full benefit of these medicines as they were going for about 16 hours (from 1700 until 0900 the next day) without the medicines. Care records of residents contain information about the wishes, instructions or arrangements that residents/representatives have made about end of life care, death and funeral arrangements. Feedback from residents’ relatives when the residents have passed away showed that the end of life care of residents was managed appropriately and sensitively by staff. DS0000063588.V342943.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All of them. People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from a range of social and recreational activities in the home and in the community to enable them to lead a fulfilling life as much as possible. Nutritious and sufficiently varied meals are provided to residents according to their preferences and choices. EVIDENCE: The home has a section in the care records that contains an assessment of the social and recreation needs of residents. This was in the main completed for each resident. There is also a format ‘getting to know you’ which is offered to relatives and friends of residents to complete. These forms provide information on the backgrounds of residents and could help in understanding the behaviour of some residents. It was noted that the ‘getting to know you’ form was not always present in care records. Management stated that at times, residents’ representatives do not always return the forms back and in some cases residents do not have close relatives who would provide information about their life story. DS0000063588.V342943.R01.S.doc Version 5.2 Page 18 The home has a full-time activities coordinator who is responsible for preparing the programme of activities. An additional part-time activities coordinator has not yet been recruited. The home has budget for activities and has a number of resources, which are kept in the activities’ room. A multi-sensory room is also available for residents. The home continues to promote ‘rummage boxes’ and ‘doll therapy’ which were seen during the inspection. The home has a number of music systems and TVs in the lounges. Three of the lounges have a video. The home has a good selection of CDs and a number of videos. The home benefits from support from the ‘friends of Woodland Hall’, which raises money, provide volunteers, and supports the home with activities. On the day of the inspection a few residents were seen engaging with a range of musical instruments and then in the afternoon some residents were involved in baking bread. Residents’ achievements were exhibited all over the home for other residents and visitors to see. These included a number of artworks, which were placed on the walls in the home or in the foyer and around the stairs. Residents’ achievements could also be seen in the garden where they have been involved in gardening and in growing vegetables. The home tends to involve residents in the community. A number of outings have been arranged during summer. One recent outing was on a canal boat. Pictures were available to show that residents had a pleasant time on that day. The home maintains links with the ‘Mayhew Animal farm’ and volunteers regularly visit the home with animals from the farms. A survey mentioned, “the home ensured that mum had contact with a Catholic priest & other Christian church representatives”. The religious needs of residents were recorded in care plans and the support that they required to maintain that lifestyle was also detailed. The inspectors were informed that representatives from the Church of England, Roman Catholic Church, Greek Orthodox Church and a Rabbi regularly visit the home to offer spiritual support to residents. Residents were observed having lunch. Those who were able to were encouraged to use the dining areas. Meals were taken by members of staff on a tray to residents, to choose which meals that they wanted to have. The preferences and type of meals that residents take was also available in a file in the kitchen, to which staff could refer to if needed. The residents were then supported with their meals by staff, according to their individual needs. The meals were served to residents who needed feeding one at a time, and the meals of those residents who required feeding but were not being fed, were left in the trolley to be kept warm until a member of staff was available for the feeding. This is good practice. DS0000063588.V342943.R01.S.doc Version 5.2 Page 19 According to the menu there should have been chicken and Yorkshire Pudding, potatoes, carrots and bean sprouts. The second choice should have been fish. For desert there should have been be syrup and coconut tart and custard with second choice of melon. All the meals identified on the menu were provided except for the Yorkshire Pudding and the syrup and coconut tart for desert. Fruits have also been incorporated in the menu. It was noted that appropriate lunch meals were offered to residents who were Asian or Jewish. For supper residents had a range of light meals and sandwiches to choose from. DS0000063588.V342943.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 ands 18. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has systems in place to ensure that complaints are suitably considered. Feedback and records show that the complaints tend to result in actions being taken to prevent reoccurrence of the issue raised by the complainant. Residents are generally well-protected from abuse, through the home’s policies, practices and staff training. Feedback and records show strong efforts being made in this respect. However, assault of one resident by another is not always viewed as abuse. EVIDENCE: The home has a complaints procedure that was previously judged as suitable. Complaints notices were on display in the entrance area the home, and were noticed within some units and bedrooms. Survey responses found that 15 relatives/advocates know how to make a complaint, with only two people being unclear on this. 16 relatives/advocates stated that the service has always responded appropriately if concerns have been raised about the care, with the other four respondents finding this to usually be the case. This reflects very favourably on the home. The four health professional responses answered to the same overall ratio. Comments included DS0000063588.V342943.R01.S.doc Version 5.2 Page 21 about never having had to make a complaint, that “all staff are kind and attentive if there is a problem to resolve”, and that the manager addresses issues as much as possible. There was additionally verbal feedback about complaints being suitably listened to and resolved, particularly that the manager will stop what she is doing and listen. The CSCI have received no complaints about this service since the last inspection. There were four recorded complaints since the last inspection, on the computer systems in the home. All were from relatives. These included upheld cases of missing items of clothing, of resident confidentiality being broken, and of institutional care practices being observed. The latter cases resulted in verbal warnings for the involved staff, and reminder memos to all staff across the home about acceptable and unacceptable care practices. Suitable records were in place for these complaints, and actions taken are seen as appropriate. It is judged that complaints are overall very suitably handled. Accident records were made available through the computer systems in the home. Checks of specific entries found suitable detail about the accident, including injuries and actions to prevent reoccurrence. Follow-up entries were generally evident, to clarify follow-up actions and occurrences, such as GP checks. The records included about unexplained scratches and bruises, which shows diligence. Accidents resulting in hospital treatment are notified to the CSCI. It was additionally noted that management review accidents monthly in detail. Incident records are similarly kept. A check of recent records found for instance the recording of a missed medication for a resident, a staff member being hit by a resident, records of deaths of residents, and records of aggression between residents. Again, records showed suitable detail and actions. However, one such latter case involved an injury to one resident. The resident’s family and GP were informed, but not the local social services team for independent consideration of the safety of the resident. A check of the company policies showed that the incident would be classed as abuse, and that informing the police should be considered in conjunction with the resident if possible. This was discussed with the manager, who agreed that all similar cases would now be referred as required. The CSCI was made aware of one adult protection (SGA) referral at the home since the last inspection. This was about a similar case to the above. Actions to protect the injured resident were taken, with no repeat occurrence having taken place. It was noted that the home has a copy of the updated version of the Harrow Safeguarding Adults procedure. There is a Care UK abuse-prevention policy, and a local policy that takes in the Harrow procedure. The manager agreed to ensure that this local policy includes about any resident being assaulted by another resident. DS0000063588.V342943.R01.S.doc Version 5.2 Page 22 The AQAA notes that staff have all received training in both protecting residents from abuse, and on working with residents who are aggressive. Training records generally confirmed this. Staff meetings include the discussion of resident protection from abuse. Feedback from staff showed reasonable understanding of how to protect residents from abuse, explanations of how the service minimises the risk of abuse, and how to work appropriately and respectfully with those residents who challenge the service. There were memos on display in some areas about abuse prevention, including some specific care practices that are not acceptable. Staff-meeting minutes showed discussion of abuse prevention. Training records confirmed that all staff have had recent training, by the manager, on abuse-prevention. There is consequently a strong focus on getting staff to understand abuse and whistleblowing. Feedback from relatives and advocates about the safety of resident was mostly positive. One person quoted, “During my numerous visits, I have never seen any of the residents being abused, degraded or made to feel inadequate.” Other relatives met during the visit concurred with this, noting that they can visit the specific unit unannounced to any staff. DS0000063588.V342943.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All of them. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in an environment that is safe but which is not sufficiently maintained, in respect of both refurbishment and making adjustments to meet the particular needs of residents who have dementia. This applies in particular to the lounges and corridors. They have signs of wear and tear to carpets, curtains and furnishings, and they lack décor that enables residents who are easily disorientated. Bedrooms, all single, tend to have more facilities, including en-suite toilets in all cases. All available toilets are judged as suitable for purpose. The home has much equipment in place to compensate for any mobility needs, including a passenger lift, rails, and adapted baths. The home is generally kept suitably clean. There are strong standards for the control of infection, although minor improvements are needed in practice. DS0000063588.V342943.R01.S.doc Version 5.2 Page 24 EVIDENCE: A few surveys made comments on the environment, for instance that “Refurbishment is badly needed: New furniture, carpets, curtains”, and “the environment is bland.” A tour of the home that included all units and a sample of bedrooms, found this to clearly be the case in some areas, for instance with carpets that have gaps between joins, tables and chairs that wobble slightly, and with the general lack of furnishings beyond basics in some lounges. Management noted that budgets for renewal of these issues had recently been agreed upon, so that for instance carpets would shortly be replaced for the first time since the opening of the home throughout all lounges and hallways. This must be promptly addressed, as the issues are repeated from previous inspections. The manager clarified however that carpet had been replaced in a few key areas, such as in a few bedrooms and in the Sunshine unit. Each unit continues to have a quiet room away from the lounge. The quality of furnishings and décor in these varied from strong, for instance in the designated ‘faith room’ in unit 6, to poor as in the sparse room in unit 5 with just three seats and worn flooring. These rooms also lacked obvious resources except for the faith room in unit 6. These rooms must all be suitably decorated and furnished. Conversely, a number of hallways and stairwells had photocollages of recent activities with written commentary. Checks of a sample of bedrooms positively found there to be sufficient light through an overhead and a wall-mounted bedside light, for there to be suitable odour, and for previous requirements of clean bed-frames and clean clothing to have been addressed. The manager confirmed that doors can be provided with locks for residents who are willing and capable of having keys. The back garden now has a number of vegetable plants growing there, which staff explained was with the involvement of some residents. There are plans for a sensory garden, and to develop the green area at the front of the home. The main toilets close to each lounge were seen to overall be sufficient for generalized needs. For instance, all had picture signs to indicate their purpose, all had soap, and to assist with anyone with failing eyesight, toilet basins and floor colours were different. Checks of the kitchenettes next to the lounges were made. Most fridges were suitably clean. Four had working bins, but the two in the male-resident areas did not work in terms of the foot pedal opening the lid suitably, to help uphold infection control standards. This must be addressed. DS0000063588.V342943.R01.S.doc Version 5.2 Page 25 The environment was also considered with respect to good practice in dementia care. Improvements in this respect are needed: • All the corridors are too similar in appearance, in terms of wall and carpet colour, which can be disorientating to any resident who becomes easily lost. It was however encouraging that within each unit, corridor floors, walls, and doors were generally of contrasting yet balanced colours, which assists anyone with visual needs. • Bedroom doors were sometimes of different colours in different units, but within each unit they were all exactly the same except for names and door numbers. Good practice for independent residents would be to explore how to make the door familiar to the resident, for instance in terms of previously-recognised colours and numbers, and/or through the use of photos or pictures. This is required. • All the en-suite toilets seen had completely plain doors, where again individualization could assist with enabling independent but disorientated residents with preventing incontinence. This should be considered. • Some bedrooms and most lounges lacked personalized effects that can help to orientate people with dementia. Consideration should be given to this. • There were no environmental impact assessments within each unit. A suitably-trained person making such assessments, based around good practice and the individual needs of the people within each unit, would benefit all residents and show suitable planning to meet needs. It was noted that the televisions in each lounge were at a low level, barely reaching eye-level for seated people, and hence easily out of view. This should be considered. One survey noted that the television in the Bluebell unit (2) did not have a connected outside aerial, instead using an indoor aerial, which resulted in poor picture quality upon changing channels. The aerial system must ensure good picture quality at all times. Environmental adaptations such as rails in corridors, a passenger lift, assisted baths, call-alarms, and zimmer-frames were very evident during the inspection. It is noted from the AQAA that a further 24 electric beds have been purchased since the last inspection, to replace the divan beds that are not adjustable to residents’ needs. A number of new hoisting devices, and a new carpet-shampooing machine have also been acquired. The home continues to have a permanent maintenance worker. Staff confirmed that they can call this person anytime, and that maintenance issues get addressed. Surveys found five relatives/advocates stating that the home is usually fresh and clean, one that it is always so, and one just making comments. Comments from relatives during the visit were that the home is always clean. The main issue from the surveys were around odour control on the first floor, and there was recognition from some that people do their best to address this. The tour of the home found one area of lingering offensive odour, in the upstairs DS0000063588.V342943.R01.S.doc Version 5.2 Page 26 hallway near the lift. Management explained the ongoing reasons for this, and it was positively found that after extensive cleaning using suitable equipment, the area returned to a neutral odour. Nonetheless, lingering odour compromises the environment. It must be permanently eradicated. A check of the dedicated laundry area found it to be clean and fully functional. It was found that, around lunchtime, there was no anti-bacterial hand-wash available from the designated points next the lounges in units 4 and 6. This compromises suitable hygiene standards, and so must be addressed. The CSCI were notified of two outbreaks of the Norovirus, within a short space of time, relating to 12 residents on the first floor earlier in the year. Suitable preventative actions were taken overall, and it was established about how the virus was likely to have entered the home. Staff were able to explain to the inspectors about suitable infection control procedures during the visit, noting that they have had both training in this respect and updates at the time of the outbreak. DS0000063588.V342943.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All of them. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ needs are generally met by the staffing levels, but there are times when they may need to wait a short time for staff support and attention. Feedback particularly found that staff have a very helpful attitude. The service ensures that all staff receive relevant training that is focussed on delivering improved outcomes for people using the service. NVQ standards are now almost met. Recruitment practices have been improved, and now sufficiently protect residents. EVIDENCE: Survey feedback found that eleven relatives/advocates consider the care staff to always have the right skills and experience to support resident’s social and health care needs, with ten people stating this as usually and no-one rating this lower than that. Health professional feedback generally agreed with this, and feedback from relatives and residents during the visit reflected this. Comments included “I have seen very caring staff when dealing with patients”, “all staff obviously care for the people they look after”, and “the nursing staff DS0000063588.V342943.R01.S.doc Version 5.2 Page 28 have been first class.” Observations from the inspection generally confirmed that staff work hard to meet residents’ needs in a polite and friendly manner. The AQAA noted about ‘adequate staffing levels in all areas’, good staff retention, and no use of agency staff. This is encouraging. One health professional and one relative noted within surveys that the care service could improve through the addition of more staff. One person explained that “this would enable more one-to-one interaction with clients.” However, survey feedback also found that five relatives usually have staff available when they need them, two stating this as always. During the visit, some relatives volunteered that staffing levels was the only area for improvement, citing for instance that they themselves provide support at mealtimes as there are otherwise not enough people to help support all residents. They also noted that more staff would enable carers to remain in the lounge whilst others provide personal care, or deal better with anyone being challenging, or locate anyone that has wandered. The suggestion was for one additional carer to cover each of the interconnected units. The manager noted that there are always ratios of eleven carers and four nurses working during the day, increasing to five in the morning, with six carers and three nurses at night. There is additionally the full-time activity worker. Carers are not expected to undertake cleaning, leaving them free to work with residents. Additional staff are also sometimes booked to work when any residents present persistent challenges. Checks of rosters found these levels to be confirmed. One case of being a carer short was identified, which documents and feedback confirmed was a short-notice cancellation of a shift by the worker. In summary, there is insufficient evidence to find that staffing levels do not overall meet residents’ needs. However, it is recognised that there is some feedback to suggest that levels in individual units are not always sufficient to meet residents’ needs. Consideration should be further given as to how to address this. It was previously required for the service to ensure that sufficient numbers of care staff achieve the NVQ qualification at level 2 in care. Records showed that 13 out of the 40 care staff have now achieved the qualification, with a further 20 currently taking it. Hence, the 50 achievement standard is yet to be met, but suitable actions are being taken to address the shortfall. Staff noted good standards of training, for instance in small groups with the psychiatrist to discuss about specific residents’ needs. Some other courses were also evident, such as a recent course in ‘listening to residents’ to which relatives were also invited. DS0000063588.V342943.R01.S.doc Version 5.2 Page 29 It was previously required to ensure that care staff have all attended formal training on emergency first aid, dementia care, and infection control. Records showed that this has been addressed fully for first aid, and mostly addressed in the other areas. The manager noted that groups of six staff are starting to be enrolled on intensive ‘Yesterday, Today, Tomorrow’ dementia courses of four to six weeks’ duration. This exam-based course should significantly help staff to have a strong understanding of the needs of people with dementia. The training records also showed that the staff team have had suitably recent training in abuse prevention and manual handling. There is now a computerized training package (‘El-Box’) that staff in all roles can access during free time at the home. This package covers such areas as fire safety, food hygiene, induction in care, abuse-prevention, and customer care. Additionally, new staff work through a local induction procedure, so that they overall are provided with induction training that meets the national training organization’s standards. One health professional noted that most nursing staff are RGNs, when RMNs would be better suited to residents with dementia or mental health needs. Records provided by the home showed that there are 6 RMNs out of the 20 nurses employed, in addition to the manager. The Statement of Purpose notes that there is always an RMN working in the home. Checks of a week’s roster however found only fourteen of the 21 shifts across that week covered by at least one RMN. This must be improved on, to uphold suitable nursing standards in the home. It was found that management monitor whether people’s nursing qualifications are up-to-date, which is appropriate. The recruitment checks of four randomly-chosen staff, all of whom started work since the last inspection, were considered. Suitable and timely documents were in place for Criminal Record Bureau (CRB) disclosures, two written references including from the last employer in the care sector where applicable, passports as identity checks, work permits where applicable, and application forms including employment histories. There was also documentation about health checks of the prospective worker, and about faceto-face interviews with two members of management. Consequently, requirements from the previous inspection relating to CRBs and references are judged to have been fully addressed. DS0000063588.V342943.R01.S.doc Version 5.2 Page 30 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager is person-centred in her approach, and leads and supports a strong staff team who have been recruited and trained to a high standard. The manager is suitably experienced and capable to run the service to residents’ benefit. There are excellent standards of communication in the home, both within the staff team and to the benefit of relatives. The home has efficient systems to ensure effective safeguarding and management of individual’s money, including through record-keeping. The home has suitable standards of health and safety management, and of quality auditing. DS0000063588.V342943.R01.S.doc Version 5.2 Page 31 EVIDENCE: The manager has many years experience of working in this field, having qualified as a general nurse and then a mental-health nurse over twenty years ago. She upholds her nursing qualification, and is continuing to work towards the registered manager’s award. She has worked at the home since it opened twelve years ago. She was promoted to the manager’s role early in 2006, and was successfully registered with the CSCI in that role last November. Discussions with the manager, on the second day of visiting, confirmed that she is very capable in the role, for instance showing elements of good care and management practice, and being aware of individual resident and staff issues. Relative/advocate feedback from surveys was very positive about how they are treated by staff and management in the home. For instance, all seven respondents noted that staff act on what they say, and all ten respondents found that they are, always or usually, kept up-to-date with important issues affecting their relative. Specific quotes included, in respect of what the home does well, “Instantly responsive to resident’s needs whilst informing the relatives of the action taken and the reasons for doing so.” Health professional feedback also found the home’s communication with relatives to be praiseworthy. A few surveys noted that the home could improve telephone communications, for instance noting that they have to phone two or three times to get through. A recent relatives’ meeting however found no-one there having these difficulties. The manager confirmed during the inspection that a new phone system was installed in June, from which some technical difficulties initially presented but which engineers had now resolved. Staff fedback positively about the support provided by management. Some staff made the particular point about there being good communication within the team, including through shift handover meetings and staff meetings. Team supervision checklists showed that staff receive an individual supervision meeting at least every two months. Sample records of the meetings showed that they consider support issues in respect of residents, health and safety, and other areas of coaching. Records are signed by both parties. Recent nurse meeting minutes noted that supervisions and appraisals are upto-date. Staff meetings are being held monthly, and include relevant topics such as on abuse-prevention, infection control, and appropriate treatment of residents. The home’s business manager has primary responsibility within the home for looking after residents’ money. He was able to explain clearly about how the systems operate. Minimal amounts are kept, securely, on behalf of the DS0000063588.V342943.R01.S.doc Version 5.2 Page 32 residents within the home. Signed receipts are kept of money received from relatives. Clear records are kept of money acquired from the bank accounts that the organisation keeps for some residents. Checks of a sample of residents’ finances found no discrepancies and clear record-keeping, including with respect to cross-checking against bank account records. There was also a receipt in respect of each purchase. A few residents look after their own finances, but can additionally have the home look after anything. There was good evidence of the home supporting purchases by residents despite the resident having no money in their home account at that time. There was evidence of auditing of some residents’ records by senior figures within Care UK during 2005, whilst the home manager undertakes spot-checks regularly. Finally, it was noted that relatives and residents may view their finance records at any time. Health and safety requirements from the last inspection have been addressed, including in the areas of having a specific heatwave plan, taking action to repair some mobile hoists, and addressing outstanding work in respect of electrical wiring. It was noted that the home has invested in a number of new mobile hoists. Internal risk assessments, in respect of the environment and collective resident safety, were seen to be in place. It was positively noted, from staff feedback, that one resident is enabled to make their own tea from one of the kitchenettes. They have to supervise the resident, not for this residents safety but because the resident is otherwise liable to distribute very hot tea to other residents which presents scalding risks to some people. A professional fire-safety risk assessment and evacuation plan was found to be in place dating from April 2007, in line with recently-changed fire-safety legislation. The fire authority have not visited the home since the last inspection, which suggests that they consider the home to manage fire safety suitably. The local environmental health department visited the home in February 2007, in respect of the kitchen and general food hygiene. The report of this noted just one requirement around equipment replacement, which management stated has been addressed. The CSCI have been sent regular updates about the home. All reports of monthly senior-management visits are forwarded promptly, whilst newsletters and bi-annual reports have also been provided when produced. These help to provide a picture of how the home as a whole is striving to make improvements for residents, noting both successes and areas where further work is needed. The bi-annual report included detailed results of the home’s survey of relatives’ opinions about the home, including example quotes. These were mainly DS0000063588.V342943.R01.S.doc Version 5.2 Page 33 positive, but areas for improvement were also recognised. The report also included updates from key figures in the home, a number of quotes from a short staff questionnaire, and details of recent resident-&-relatives’ meetings. It was positive to note that these latter meetings include both management and the activities worker, as this assists with direct communication. Management noted that surveys have been recently distributed again, as part of the current quality auditing process. A suggested area for improvement is to continue to search for ways of enabling residents to feedback about the services provided. DS0000063588.V342943.R01.S.doc Version 5.2 Page 34 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 2 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X 4 X X 3 DS0000063588.V342943.R01.S.doc Version 5.2 Page 35 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 OP1 Regulation 5 Requirement The SUG must be updated to contain information about the range of fees charged by the home, about what the fees cover, and the home’s philosophy of care with regards to the provision of dementia care. All residents’ care plans must set out in detail the actions that need to be taken to meet the health, personal, and social care needs of residents. Previous timescale of 01/11/06 not fully met. That care plans are updated as and when there are changes in the needs of residents. That individual risk-assessments 01/12/07 are provided, for residents who have a small gate in front of their room to prevent other residents from going in, as this could be a limitation to the freedom of the former. The assessment must include consultation with relevant people such as the resident, next-of-kin, DS0000063588.V342943.R01.S.doc Version 5.2 Page 36 Timescale for action 01/12/07 2 OP7 15 01/11/07 3 OP7 13(7) 4 OP8 12(1) and relevant health professionals. That the standard of the provision of oral hygiene is reviewed in the home and that care records are updated to include the action to take to meet the oral care of residents, to make sure that residents enjoy a high standard of oral care. That residents are shaved according to their choices and preferences to ensure a high standard of personal care. The registered person must consider making arrangements for residents to be seen yearly by the dentist, in addition to when required. The amounts received of all medicines must be recorded, and the instructions for the administration of topical medicines must be clarified, for the safety of residents. Medicines must be administered as prescribed, and these must be administered at regular intervals as far as possible to ensure that residents fully benefit from the medicines that have been prescribed. Any cases of a resident being assaulted by another resident must be reported to the appropriate Harrow Social Services department for consideration under their Safeguarding procedures. This is to ensure independent consideration of the incident, and hence that suitable actions are being taken to protect residents. The aerial system within each unit must ensure a good-quality DS0000063588.V342943.R01.S.doc 01/10/07 5 OP8 13(1)(b) 01/02/08 6 OP9 13(2) 01/10/07 7 OP9 13(2) 15/10/07 8 OP18 13(6) 01/10/07 9 OP19 23(2)(c) 15/10/07 Page 37 Version 5.2 10 OP19 23(2)(b, d) television picture at all times. This was not the case in unit 2, where an indoor aerial was being used. Many of the soft furnishings of the communal living areas require further refurbishment. Carpets, curtains and some furnishings in particular, were very worn. This must be addressed. Previous timescales of 1/2/06, 1/6/06 and 1/12/06 not met. All the corridors are too similar in appearance, in terms of wall and carpet colour, which can be disorientating to any resident who becomes easily lost. This must be addressed. Bedroom doors within each unit were all exactly the same except for door numbers and names. For ambulant residents, it must be explored about how to make the door most familiar to the resident, for instance in terms of previously-recognised colours and numbers, and/or through the use of photos or pictures. This can help to orientate individuals. The small, second lounges within each unit must all be suitably decorated and furnished, so as to be appealing for residents’ use. The majority were not. The tour of the home found one area of lingering offensive odour, in the upstairs hallway near the lift. This compromises the homeliness of the environment. It must be permanently eradicated. Suitable hygiene standards must be upheld in the following areas: • Ensuring that anti-bacterial DS0000063588.V342943.R01.S.doc 01/02/08 11 OP20 23(2)(n) 01/02/08 12 OP20 23(2)(n) 01/12/07 13 OP20 23(2)(b, d) 15/12/07 14 OP26 16(2)(k) 01/10/07 15 OP26 16(2)(j) 01/10/07 Version 5.2 Page 38 16 OP27 18(3) hand-wash is always available from the designated points next to the lounges. This was lacking in units 4 and 6 during the lunchtime of the inspection. • Ensuring that kitchenette bins are easy to open. Those in units 5 and 6 had foot-pedals that failed to open the lids sufficiently. As per the home’s Statement of 01/11/07 Purpose, and to better meet the needs of residents, there must be an RMN-qualified nurse working in the home at all times. 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 OP7 Good Practice Recommendations To ensure that the nutritional needs of individual residents are kept under regular review, the manager should ensure that the nutritional risk assessment is reviewed at least monthly or more often as and when the needs of the resident changes. The overall score of the falls risk assessment for individual residents should be worked out, to identify the level of risk faced by the resident and to enable appropriate action to be taken. It is recommended that the care of residents who are excessively sleepy during the day be reviewed, to make sure that this is not caused by something which can be resolved. The home should ensure that it complies with the menu at all times to make sure that residents always receive nutritious and well-balanced meals. The home’s local procedure on abuse-prevention should include about procedures to follow when any resident assaults another resident. It was noted that the televisions in each lounge were at a DS0000063588.V342943.R01.S.doc Version 5.2 Page 39 2 OP7 3 OP8 4 5 6 OP15 OP18 OP19 7 8 OP19 OP22 9 OP23 10 11 OP27 OP33 low level, barely reaching eye-level for seated people, and hence easily out of view. This should be considered. Some bedrooms and most lounges lacked personalized effects that can help to orientate people with dementia. Consideration should be given to this. A suitably-trained person should be acquired to make environmental-impact assessments around the home, based around both good practice in dementia care and the individual needs of the people within each unit. Consideration should be given to individualizing en-suite toilet doors, rather than having them completely plain, as this might assist with enabling independent but disorientated residents to access the area more easily. Consideration should be further given about how to address the feedback that staffing levels in individual units are not always sufficient to meet residents’ needs. A suggested area for improvement is to continue to search for ways of enabling residents to feedback about the services provided. DS0000063588.V342943.R01.S.doc Version 5.2 Page 40 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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