Latest Inspection
This is the latest available inspection report for this service, carried out on 23rd February 2010. CQC found this care home to be providing an Adequate service.
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 1 statutory requirements (actions the home must comply with) as a result of this inspection.
For extracts, read the latest CQC inspection for Silverwood Nursing Home.
What the care home does well People received the care they needed and care plans were personalised. People told us that they liked the regular staff and that they were `kind`. The company had a clear complaints procedure and addressed peoples` issues and provided a written response. What the care home could do better: There must be clear lines of accountability so that people know who to go to if they have concerns. This must include a designated manager and permanent qualified nursing staff. Heavy reliance on temporary staff does not ensure that there is consistency of care or that people and their visitors know who to go to if they have a concern. Care plans must be updated regularly on a monthly basis to ensure that all needs identified are addressed in a timely manner and records must clearly indicate the outcomes of nursing treatments. Medication procedures must improve to ensure that peoples` medicines are in stock and that they received them as prescribed. Random inspection report
Care homes for older people
Name: Address: Silverwood Nursing Home Imperial Road Beeston Nottingham Notts NG9 1FN one star adequate service 10/11/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Janet Morrow Date: 2 3 0 2 2 0 1 0 Information about the care home
Name of care home: Address: Silverwood Nursing Home Imperial Road Beeston Nottingham Notts NG9 1FN 01159253699 01159430715 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Modelfuture Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 80 Number of places (if applicable): Under 65 Over 65 80 0 old age, not falling within any other category physical disability Conditions of registration: 0 3 The manager will be based within the home 5 days each week The managers hours are not included in the qualified nurse requirement Date of last inspection Brief description of the care home Silverwood is a purpose built large care service consisting of two units separated by a kitchen and walkway. East wing mostly accommodates people with nursing needs and West wing mostly accommodates people with personal care needs. The premises are split over two floors on each Wing. Both have offices, bathrooms, bedrooms and
Care Homes for Older People Page 2 of 9 1 0 1 1 2 0 0 9 Brief description of the care home lounge/dining areas. There are gardens to all sides and a car park to the front of the building. The weekly fees ranged between £373.92 to £522.11 per week. Extras include hairdressing, chiropody and some toiletries. No day care or intermediate care was being provided at the time of the last Key Inspection. Copies of the latest inspection report can be found in the services foyer and can be located on the Care Quality Commissions website, www.cqc.org.uk Care Homes for Older People Page 3 of 9 What we found:
We looked at two peoples care records. A care plan was in place for both people and there were associated records that showed attention was paid to identified risks, such as nutritional risks, risk of falls and risk of pressure sores. The risk assessments for these were reviewed on a monthly basis. The care plans were detailed and personalised and gave clear instructions to staff on what they should do. However, they were not reviewed on a consistent basis. For example, one plan had not been evaluated since October 2009. The plan identified a high nutritional risk and said weight should be recorded monthly. However, there was no weight recorded for November and December 2009. One persons plan for dealing with a wound lacked clarity. It was not explicit that it had healed; the last record seen stated that it was almost healed and further entries two months later were not clear if they referred to the same wound or a new one. Staff spoken with could not give a clear explanation of the entries. Neither care plan seen had any evidence that the people concerned had been consulted about the care to be provided. For example, neither plan had a signature although both people concerned were able to sign. Issues regarding care planning had been identified at the previous inspection in November 2009 and requirements made had not been fully addressed by the due date. This resulted in a notice being issued under Part 11 of the Care Standards Act 2000 (sections 31 and 32) to remove documentation relating to the non-compliance. Two people and one relative were spoken with during the visit. Generally, they felt essential care tasks were completed but identified the main issues as inconsistency of staff, particularly nursing staff, as there had been no regular nurses at the service for several weeks and cover was provided from other services operated by the provider and bank staff. This led to frustration in having to explain things repeatedly and staff not having a knowledge of the individuals concerned. A relative spoken with confirmed this when speaking about her recent experience, which resulted in making a complaint. Medication administration record (MAR) charts were examined. A random sample of six charts were examined. These showed that generally the charts were completed properly although there was room for further improvement; for example, charts had no signature for one medicine on one day and handwritten charts were not consistently being signed by two people. There were also nutritional supplements and a non-essential medicine that were out of stock. This was discussed with the nurse in charge, who stated that these had been chased up with the pharmacy and written confirmation was provided the following day that these medicines had been received. Two peoples medication records were then examined in more detail. This identified that one medicine for one person had not been signed as administered but the tablet was not available in the blister pack. The nurse in charge could not give an explanation of why the tablet was not available. Care Homes for Older People Page 4 of 9 Issues regarding medication procedures had been identified at the previous inspection in November 2009 and requirements made had not been fully addressed by the due date. A notice was therefore issued under Part 11 of the Care Standards Act 2000 (sections 31 and 32) to remove documentation relating to the non-compliance. In the absence of the acting manager, discussion took place with the administrator regarding two recent complaints received by the service and the Commission. Both of these were still under investigation by the company and letters had been sent to the complainants stating they would receive a response within twenty-eight days. The staff rota for East Lodge nursing wing for February 2010 was examined. This showed that there was one nurse on duty for all shifts and four care staff for the morning and afternoon shifts and two on the night shift. This was consistent with the number of staff on duty during the inspection visit. People spoken with and their relatives sometimes felt there were insufficient staff and there could be an average waiting time of ten minutes when help was requested. Neither person stated that this had had a negative impact on their well being and one felt the key issue was because of the number of staff who were new to the service and the lack of accountability as there was no permanent nurse with whom to take up any care issues. However, the perception of service users was that there were not enough carers. The staff training matrix was examined and this identified who was out of date with mandatory training and when training had occurred. It showed that moving and handling training and safeguarding vulnerable adults training had taken place since the last inspection visit in November 2009. The management structure was discussed with the administrator and she advised that the provider had made a public notice stating what arrangements were in place for management accountability. She also stated, and this had been confirmed in writing to the Commission prior to the inspection visit, that an acting manager was in place and covering the service currently and a permanent manager was starting on 3rd March 2010. Nursing staff familiar with Southern Cross procedures were on loan from another of their services and were covering some of the nursing shifts to try and increase stability in the short term. Both people using the service who were spoken with said that it was not like it used to be and felt the general running of the service had deteriorated. A fire risk assessment was in place and the five yearly check on the electrical wiring was up to date as required at the previous inspection visit in November 2009. What the care home does well: What they could do better: Care Homes for Older People Page 5 of 9 There must be clear lines of accountability so that people know who to go to if they have concerns. This must include a designated manager and permanent qualified nursing staff. Heavy reliance on temporary staff does not ensure that there is consistency of care or that people and their visitors know who to go to if they have a concern. Care plans must be updated regularly on a monthly basis to ensure that all needs identified are addressed in a timely manner and records must clearly indicate the outcomes of nursing treatments. Medication procedures must improve to ensure that peoples medicines are in stock and that they received them as prescribed. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 9 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 7 15 People must have a plan of care in place that clearly details all of their care needs. This must be completed in a timely way following admission. Care plans must identify all personal details about the person. This is to ensure no care needs are overlooked. 31/01/2010 2 7 15 Records must support that people have been consulted about their plan of care. This is to ensure care is planned in a person centered way and that people have their rights upheld. 31/01/2010 3 9 13 People must receive the 31/01/2010 medication they require. People who are selfmedicating must have the appropriate documentation and storage arrangements in place. Staff must receive further training in safe management and administration of medicines. This is to ensure people are safely cared for and receive the medication they need. Care Homes for Older People Page 7 of 9 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 31 9 There must be a manager in place who is registered with the Care Quality Commission. This is to ensure the service is run in the best interests of people using it and to meet legal requirements. 30/06/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 2 9 27 Hand written medication charts should be checked and signed by two people to ensure they are accurate. The service should review its staffing rotas to ensure consistency of staff and to ensure care is delivered in a timely manner. Care Homes for Older People Page 8 of 9 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 9 of 9 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
