Care Home: Stretton Nursing Home

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What the care home does well The home is very well presented to prospective clients both in general appearance and in the excellent sources of information provided. The home provides very person centred personal care in a friendly, homely atmosphere and a very pleasantly maintained environment. Service users receive good standards of care and support delivered in an individual way and in the way the resident wishes by well-trained staff. The home delivers safe services such as medication administration, a safe and healthy environment and has adult protection as a priority. The home is managed well and regular quality assurance monitoring assists in maintaining this and promoting further developments. Service users are in particular pleased with the high standard of the meals and also find the gardens a good source of pleasure. The staff group is very stable with many having been employed for many years. There is a commitment to staff training and supervision that ensures care practice is of a high standard. What has improved since the last inspection? Care planning continues to improve and identity of needs and care planning is now good and remains a priority with the manager and training officer. A programme of refurbishment and redecoration is well progressed and some stained carpets have been replaced, others are planned in. All residents bedroom doors have been fitted with automatic closures. Cleaning routines have been improved to give better assurances that standards can be maintained. A relatives group, "Friends of Stretton" has been established and is another means of promoting good communications. What the care home could do better: On going development of care plans is required and must ensure timely responsiveness to changes, more direction to staff for potential medical condition deteriation and better referencing to other documents that support the process. During the absence of an activities co-ordinator staff must both maintain the regular programme and ensure that in so doing, do not detract from delivering care. The programme of refurbishment and redecoration and carpet replacements should continue and the carpeting of the corridor in Woodlands should go ahead. The fitting of a sluice disinfector and improvement of the call system should be seen as priorities. Accident records should be audited and then filed under individual files in keeping with the guidance in the accident book. CARE HOMES FOR OLDER PEOPLE Stretton Nursing Home Stretton Nursing Home Manor Fields Burghill Hereford Herefordshire HR4 7RR Lead Inspector Richard Eaves DRAFT: Key Unannounced Inspection 09:00 5th November 2007 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 Stretton Nursing Home DS0000062332.V341008.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. Stretton Nursing Home DS0000062332.V341008.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stretton Nursing Home Address Stretton Nursing Home Manor Fields Burghill Hereford Herefordshire HR4 7RR 01432 761611 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) Stretton Care Ltd Sylvia Mary Steed Care Home 50 Category(ies) of Dementia (50), Dementia - over 65 years of age registration, with number (50), Old age, not falling within any other of places category (50), Physical disability (50), Physical disability over 65 years of age (50), Terminally ill (50) Stretton Nursing Home DS0000062332.V341008.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents` with care needs associated with dementia illnesses may only be admitted to the Home where these are secondary to the person`s care needs. Date of last inspection Brief Description of the Service: Stretton Nursing Home provides nursing care for up to 50 people. A range of registration categories are in place allowing a service to be provided to people with physical care needs, those arising from dementia illnesses and people who have terminal illness. Residents’ whose care needs are associated with a dementia illness are only able to be admitted to the home where the dementia care needs are secondary to any physical disability and care they may require. The accommodation is provided in a single storey building which is situated in a peaceful rural location just outside Hereford. The building is operated as two wings with independent staff teams and separate communal rooms. The accommodation is within shared and single rooms. The home provides a range of equipment for residents’ with physical disabilities. The current scale of fees are from £493 - £572 per week. The fee information given applied at the time of the inspection, persons may wish to obtain more up to date information from the home. Stretton Nursing Home DS0000062332.V341008.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection visit was undertaken by an Inspector from the Commission for Social Care Inspection using the following information: reports from the organisation relating to the conduct of the home, records maintained at the home, the annual quality assurance self assessment, comment card responses from service users, relatives and other stakeholders such as GP’s and visiting Nurses. The inspection included a full tour of the premises including, bedrooms, the communal rooms and service areas and provided an opportunity to speak with many of the service users and some visitors present during the day. What the service does well: What has improved since the last inspection? Care planning continues to improve and identity of needs and care planning is now good and remains a priority with the manager and training officer. A programme of refurbishment and redecoration is well progressed and some stained carpets have been replaced, others are planned in. All residents bedroom doors have been fitted with automatic closures. Cleaning routines have been improved to give better assurances that standards can be maintained. A relatives group, “Friends of Stretton” has been established and is another means of promoting good communications. Stretton Nursing Home DS0000062332.V341008.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Stretton Nursing Home DS0000062332.V341008.R01.S.doc Version 5.2 Page 7 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 Stretton Nursing Home DS0000062332.V341008.R01.S.doc Version 5.2 Page 8 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): Standards 1 – 5 Quality in this outcome area is good. The homes statement of purpose and service user guide is a good source of information providing details of the service enabling service users and families to make informed decisions about admission to the home. Pre-admission assessments are undertaken by the most experienced staff and confirmation is given to the service users that their needs can be met by the home and further confirmed by contract at the time of admission. Service users are invited to visit and trial the home before committing themselves to staying at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Stretton Nursing Home DS0000062332.V341008.R01.S.doc Version 5.2 Page 9 The statement of purpose and service users guide has been subject to a recent in depth review and reissued, it is a good source of information for current and prospective service users. A copy of the service user guide was seen in each of the bedrooms visited. A copy of the contract/terms and conditions was seen for each service user included in case tracking. Service user survey responses confirmed that they had received a contract. Six service users were selected for inclusion in case tracking, and include both areas of the home. The assessment process for each of the files inspected was generally thoroughly completed and informative and consisted of a activities of daily living model and a range of risk assessments for nutrition, pressure areas manual handling and service user specific risks such as need for bed rails and smoking. The files evidence the involvement of service users and their relatives in the assessment process. A number of minor omissions were observed, including a high risk pressure score not supported by a care plan, appropriate needs responses such as mattress and cushion supplied and the service user managed safely without pressure damage were noted. Ongoing weight loss for a service user shows no record of it being assessed by the GP or Dietician, although the GP has been attending the service user regularly and dietary supplements provided. A service user with epilepsy had no assessment of risk for status and hence no contingency plan, the service users history suggests the risk to be low. New service users are offered the opportunity to visit prior to accepting a place at the home, the survey responses said that they had sufficient information about the home before choosing it and those spoken with said they knew of the home and one relative said they chose the home having experience other care settings. The home does not provide an intermediate care service. Stretton Nursing Home DS0000062332.V341008.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7 – 10. Quality in this outcome area is good. Care plans are derived from a comprehensive range of assessments and provide the basis for the delivery of care and detail the actions required of staff to meet the identified needs. Health care needs of service users are fully met. Medications are well managed all facilitating the promotion of service users health. Service users are treated with respect and their privacy upheld. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The sample of case files were selected to be inspected and case tracked were drawn from the assessed needs process and were relevant and maintained to a good standard. The care plans reflect actual care requirements but would benefit from more detailed direction of the actions required of staff. Plans are subject to monthly review and regularly audited by the manager. All service users are registered with a GP and allied medical services such as dentist, ophthalmic and chiropody are provided on a regular and as required basis. Stretton Nursing Home DS0000062332.V341008.R01.S.doc Version 5.2 Page 11 The care plans are overall well developed but still need ongoing development, in particular detailed contingency planning for identifying and directing responses to possible emergencies arising from medical conditions such as epilepsy and diabetes. The practice of documenting wound care plans and pressure relieving equipment in use elsewhere than the case file requires reference to that arrangement within the care plan. A plan for pressure care identified a grade 2 pressure sore at admission, subsequent daily reports identifies treatment appropriate to further breakdown but no review was documented. Judgements made to use particular equipment below the dependency rating the assessment identified should be documented. For example the choice of a medium dependency overlay mattress instead of a high dependency mattress. Good reasons for this can be made. None of the case files viewed had accident reports included; these were found to be in a file used for auditing. They should be filed individually and be available to inform the maintaining safety care plan reviews. A bottle system is used for the administration of medicines provided by a local chemist who has recently taken on all medication supplies and will also audits the service on a quarterly basis. An inspection of the administration of medication procedure identified that it is administered to a satisfactory level. Medications are stored in a medication store and within locked cupboards and trolley, records are maintained of medicines received and a contract is in place for disposal of unused medicines. Monitoring of room and refrigerator temperatures are undertaken. The current medicine administration record (MAR) provided evidence of drugs being booked into the home and double signing taking place to verify handwritten amendments, care plans are in place for as required medication. The medication trolley was in good order with the date of opening recorded on items as appropriate. The receipt, administration and disposal of Controlled Drugs are recorded in a Controlled Drugs register and the storage complies with regulation. Qualified Nursing Staff undertake the administration of medicines and all have undertaken updates recently. Two staff spoken with said the management of medications at the home was good. The induction programme includes a section on treating service users with respect and their privacy is upheld, locks are fitted to bedroom doors, staff were observed to knock before entering bedrooms and interact in a friendly and open way using the service users choice of name. Double rooms have screening fitted to provide privacy. Three GP survey responses said they saw their patients in private. One relative said that “the home would always get in touch I something is wrong”, “the home does look after its residents very well and the carers chat to the residents and keep them happy”. Once again the response time by staff to the nurse call is a problem in that the sound of the bell is not repeated across the home. A care manager comments positively about improvements in the home with regard to care planning and act on recommendations at reviews and take constructive criticism positively, another Stretton Nursing Home DS0000062332.V341008.R01.S.doc Version 5.2 Page 12 said “the manager and nurses are open to discussion and recommendations and openly engage and always available to visiting allied professionals”. Stretton Nursing Home DS0000062332.V341008.R01.S.doc Version 5.2 Page 13 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): Standards 12 – 15. Quality in this outcome area is good. The home provides a varied social and recreational activities that provide interest and pleasure for the residents. Visitors are welcome and help to keep service users informed about the wider community Many aspects of care evidences that service users exercise choice and control over their lives. The meals at Stretton Nursing Home are good and the home is able to cater for special dietary needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The activity co-ordinator post has recently become vacant, the manager identified that while recruitment is underway care staff undertake the role during the afternoon and maintain the weekly programme. Case files included for case tracking included a social profile and assessment of likes for entertainment and recreation. The manager must ensure that carers leading the daily activities programme are not detracting from the delivery of care. Survey respondents acknowledge the provision of activities but none offered additional comments. Those spoken with said there is plenty going on mostly Stretton Nursing Home DS0000062332.V341008.R01.S.doc Version 5.2 Page 14 during the day, they also were looking forward to a fish and chip supper evening on this day. One service user occupying his room said he chose not to participate in the activities and preferred his own company, with the radio, tv and video. The home has an open visiting policy and relatives were observed to take advantage of this being seen to visit across the day. The relative survey responses said they were made welcome, staff are very friendly, staff are chatty with the residents and keep them happy, I get a nice cup of tea and a sandwich, that never happened at other homes. The home is not appointee for any service user but does accept personal allowances from their relatives for safekeeping and records of all transactions are maintained, information of advocacy services is available. Many bedrooms were observed to have personal possessions and in conversation a lady said they were told that they could bring some furniture with them at admission. Most bedrooms visited were personalised with pictures and ornaments. Access to personal records is made clear in the service users guide and the files evidence service user involvement in their reviews, but in conversation it was apparent that they were not much interested and were satisfied with the delivery of care. The home has a 4-week rolling menu that is well thought out and offering variety and a balanced diet to service users, choice of lunch meal including a cooked option is always available and a record kept of individual service users intake and meals taken in the setting of their choice. Regular satisfaction surveys are undertaken of the meals served. The main meal of the day is served at lunch and well received. One survey respondent said “Not all meals are nice and sometimes we are not asked what we’d want to eat just given it”. Others answered ‘Usually’ to the question, do you like the meals at the home. In conversation service users responses were positive about the meals and said they enjoyed the food at the home. Four meals are provided each day including supper and snacks are served mid morning and mid afternoon. Therapeutic and cultural dietary needs can be met and soft and liquidised meals are presented with each item prepared and served to maintain a good appearance on the plate. Staff were observed to offer discrete assistance during lunch and the mealtime appeared social, relaxed and unhurried. Stretton Nursing Home DS0000062332.V341008.R01.S.doc Version 5.2 Page 15 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): Standards 16 & 18. Quality in this outcome area is good. The home has a satisfactory complaints policy and service users and their supporters can be confident that their views will be listened to and acted upon. Staff undertake adult protection training preparing them to uphold the welfare of the service users and to protect their rights. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is readily accessible to service users and their supporters with reference in the contract, the procedure is available in the service user guide issued to each bedroom. There is good recording of concerns including very minor ones, the responses were positive and a relative spoken with said the manager and staff were receptive to questions and they were comfortable to raise issues. Relative survey respondents answered yes to the question if they knew how to make a complaint except one who replied can’t remember. Comments include, “All I have to do is have a word with someone in reception and all my questions are answered, but so far no complaints”. Service user survey respondents said they new how to complain and one said, “yes I speak to Matron”, in answer to who to speak to if unhappy. The home has robust procedures for responding to any suggestion of abuse and in-house training is given in adult protection procedures both at induction Stretton Nursing Home DS0000062332.V341008.R01.S.doc Version 5.2 Page 16 and with ongoing updates. Policies were available for managing violence, restraint and whistle blowing. Staff receive training in adult protection with regular updates, discussions with staff they were able to confirm their understanding of abuse. Stretton Nursing Home DS0000062332.V341008.R01.S.doc Version 5.2 Page 17 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): Standards 19 & 26. Quality in this outcome area is good. The home provides an improving standard of décor, furnishings and managed services providing a safe, disabled accessible environment and an attractive, and homely place to live. The home is clean, free from odours and hygienic, the lack of a sluice/disinfector detracts from the progress made. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Stretton Nursing Home is set in extensive gardens well maintained, there is ample parking and the setting gives very pleasant rural views. The home is single storey and offers accommodation in 28 single bedrooms some of which have en-suite facilities. 11 double bedrooms of which 4 have en-suite facilities a number of doubles are used as singles. The home has 5 sitting rooms. The standard of the décor in the home is good with a programme underway for both internal and external parts of the home a programme of refurbishment Stretton Nursing Home DS0000062332.V341008.R01.S.doc Version 5.2 Page 18 and carpet replacement is ongoing. The rooms are furnished with good quality furniture and are bright and cheerful. Since the last inspection a head housekeeper has been appointed and cleanliness overall has been improved. Examples of wc’s requiring descaling was seen otherwise good standard is being achieved. The lack of a sluice disinfector means that chemical disinfection has to be undertaken with all the difficulties/risks this presents. The laundry facility is good and personal protective equipment is readily available. The home call system is available throughout the home but the low sound level means that in some places it cannot be heard by staff resulting in delayed responses that causes distress as described by one service user, “they don’t always come when I press the button for toilet and it leaves me in a mess”. Previous problem of wedged doors has been resolved with the fitting of fire alarm integrated door holders. Stretton Nursing Home DS0000062332.V341008.R01.S.doc Version 5.2 Page 19 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): Standards 27 – 30. Quality in this outcome area is good. The home has a stable, well-motivated and trained staff group offering consistency of care and enthusiasm to maximise the quality of life for the service users. Service users are further protected by good recruitment and selection practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The rotas confirm that staff numbers across the 24hour period are appropriate to the needs of service users. Numbers are 7 carers and 2 nurses am, 6 carers and 2 nurses pm and 2 carers with 2 nurses at night, speaking with senior and more junior staff they indicated that they consider these numbers to be adequate, the day ratio being close to 1 member of staff to 5, there being 44 service users. The home employs a number of overseas nurses currently in carer positions and these with high level skills and knowledge and those currently holding NVQ qualifications exceed the standard at 61 . Two further staff are currently enrolled on NVQ training. A sample of three staff files including a recently employed staff, show these to be completed to a good standard with appropriate pre-employment checks Stretton Nursing Home DS0000062332.V341008.R01.S.doc Version 5.2 Page 20 being undertaken. The 12 week induction programme is to skills for care standard. Staff are issued with the General Social Care Councils code of conduct. Staff each have a training file and have a training needs analysis each year, the files show that all mandatory training is provided and certificates held on file. An experienced nurse is identified as the training officer and the training room is well equipped. Supervision and appraisals were seen to be up to date and on target to meet the six sessions for the year. Stretton Nursing Home DS0000062332.V341008.R01.S.doc Version 5.2 Page 21 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): Standards 31 – 33, 35,36 & 38. Quality in this outcome area is good. Leadership of this home is good and staff demonstrate an awareness of their roles and responsibilities and service users benefit from this consistency. The ambience of the Home is warm, friendly, and inclusive. Staff receive supervision and direction to ensure that the service users receive consistent quality care. Environment management and staff training in respect of health and safety ensures service users safety and welfare are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The newly appointed manager at the last inspection has completed the registration process and brings a wealth of knowledge and experience to the home, which has been applied effectively over the summer months the role of training officer brings additional qualitative managerial input. Staff met and Stretton Nursing Home DS0000062332.V341008.R01.S.doc Version 5.2 Page 22 engaged in conversation are well motivated and have a good approach to team working and supporting one another. Service users and relatives views are regularly surveyed using a range of questionnaires that between them cover all aspects of service. A range of audits are undertaken by the manager and staff and the owner undertakes the regulation 26 visits. The Home does not act as appointee for service users but do assist service users in keeping their personal allowance safe with full records of all transactions. Audited accounts are held at headquarters and were not available during this inspection. Insurance certification was available and displayed. Supervision notes seen by the inspector demonstrate an effective formal supervision process for staff of at least six times per year. Annual appraisals have also been undertaken. Policies and procedures are available for staff to read. Health and Safety is given appropriate priority with a broad range of monitoring and maintenance in place with all staff receiving health and safety training at induction and ongoing at appropriate intervals. During the tour of the building it was observed that all corridors were clear of obstructions and the premises are kept in a safe condition. The fitting of automatic door closures has greatly improved fire safety and the eradication of door wedges. Appropriate arrangements are in place for the monitoring, recording and reporting of accidents. An inspection of the service and inspection certificates identified these to be up to date. Stretton Nursing Home DS0000062332.V341008.R01.S.doc Version 5.2 Page 23 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 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 3 X 3 3 X 3 Stretton Nursing Home DS0000062332.V341008.R01.S.doc Version 5.2 Page 24 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 OP26 Regulation 13 Requirement Stained carpets must be cleaned and/or replaced. Timescale 03/01/07 part met and replacement ongoing. Care plan reviews and monitoring systems must be responsive and directive to guide staff. E.g. A service user losing weight must be referred to the GP or dietician at a clearly defined stage. Needs identified during the assessment process must have a care plan on the case file or reference to another place e.g. dressings folder. The call bell system must be improved so that residents have access to a call bell wherever they are in the building and staff are made aware as soon as someone presses their bell. Timescale 30/09/07 part met in availability of cords, the sound level needs to be higher or repeated about the premises. Timescale for action 31/03/08 2. OP7 15 31/12/07 3. OP7 15 31/12/07 4. OP22 16 31/03/08 Stretton Nursing Home DS0000062332.V341008.R01.S.doc Version 5.2 Page 25 5. OP26 13(3) A sluicing disinfector must be provide at the home for the safe disposal and cleansing of sanitary equipment. 31/03/08 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 OP12 Good Practice Recommendations The care plans need to include more information about individualised activities or pastimes for residents who are unable, or prefer not to take part in group activities. The process is well progressed and should be continued to completion. Contingency care plans for conditions such as epilepsy and diabetes needs further development to improve description of signs of deteriating condition. Professional judgement contrary to tool guidance should be justified within the care plan. E.g. using a lower dependency pressure-relieving mattress than the tool score would suggest. In using carers to lead activities while the co-ordinator role is vacant, action must be taken to ensure care duties are fully maintained. Accident records must be filed on individuals files following the process of auditing. 2. 3. OP8 OP8 4. 4. OP27 OP38 Stretton Nursing Home DS0000062332.V341008.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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. Extracts may not be used or reproduced without the express permission of CSCI Stretton Nursing Home DS0000062332.V341008.R01.S.doc Version 5.2 Page 27 - 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. 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