Inspection on 18/09/09 for Cadogan Court

This is the latest available inspection report for this service, carried out on 18th September 2009.

CQC found this care home to be providing an Good 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cadogan Court 26/06/08

Cadogan Court 06/07/06

Cadogan Court 10/02/06

Cadogan Court 14/10/05

Cadogan Court 20/01/05

Cadogan Court 20/07/04

Cadogan Court 04/02/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Random inspection report Care homes for older people Name: Address: Cadogan Court Barley Lane Exeter Devon EX4 1TA two star good service 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: Rachel Fleet Date: 1 8 0 9 2 0 0 9 Information about the care home Name of care home: Address: Cadogan Court Barley Lane Exeter Devon EX4 1TA 01392251436 01392410097 hmitchell@rmbi.org.uk www.rmbi.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Helen Mitchell Type of registration: Number of places registered: Conditions of registration: Category(ies) : Royal Masonic Benevolent Institution care home 70 Number of places (if applicable): Under 65 Over 65 70 70 old age, not falling within any other category physical disability Conditions of registration: Registered for up to 15 - OP with nursing Date of last inspection Brief description of the care home 0 70 Cadogan Court provides accommodation for up to 70 people over retirement age. It is registered to provide nursing care for up to 15 people, and residential care for up to 70 service users. The home does not offer intermediate care. Until recently, it was a requirement for prospective residents that they have Care Homes for Older People Page 2 of 13 Brief description of the care home professional links with the Royal Masonic Benevolent Institute (RMBI), but this no longer applies. The home is purpose-built, and stands in its own grounds on the outskirts of Exeter. There is some car parking space. The home has its own transport . A local shop and public transport routes are available nearby. The home has three levels, with lift access to all areas. There are various communal facilities around the home: several large lounges and smaller sitting rooms, a large dining room, kitchenettes, laundry facilities that can be used by individuals, a library and a chapel. All bedrooms have en suite facilities. Weekly fees at the time of the last key inspection were 470 - 743 pounds. These did not include the cost of theatre outings/concerts (charged at 50 of the ticket price), magazines/newspapers (variable), toiletries (variable), hairdressing, chiropody, and aromatherapy. Up-to-date information about fees can be obtained from the home. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk. Our previous inspection reports about the home (produced under the previous commission, CSCI) are kept at the reception in the homes entrance hall. Care Homes for Older People Page 3 of 13 What we found: We carried out this random inspection to follow up the providers proposed action subsequent to their investigation of a serious complaint. We made an unannounced visit to the home which lasted just under 8 hours. The registered manager, Helen Mitchell, was present; we discussed our findings with her at the end of our visit. She and her staff assisted us fully throughout the day. We did not inspect all the core National Minimum Standards as we do at a key inspection, but looked at care planning, health care, handling of complaints and aspects of quality assurance. The original complaint related to various inadequacies encountered with the care of someone admitted to the home. At the time of their admission, the person was not deemed to have nursing needs but they had high levels of care needs. Thus we casetracked two people who had high levels of need but not nursing needs, during our visit. This meant we looked in some depth at their care and associated records, spoke with them and with three staff who supported them about their care, and looked at some management systems related to the delivery of care. This included changes made by the service as a result of the complaint investigation. The providers report on the investigation indicated that aspects of record keeping, communication and care were to be addressed, with some of the proposed action not specifically required by regulation. Our focus was on how effectively the complaint was dealt with in terms of outcomes for people who live at the home and improving the quality of the service they receive. Both people that we case-tracked looked well cared for, in that their personal care needs had been attended to and their clothes looked clean, etc. Information in their care plans explained why they did not have their dentures or hearing aids in place, where relevant. When we met them, they were sitting in their bedrooms, which were homely, clean, well kept and free of malodours. We looked at care-related records. The homes policy on care planning indicated that peoples care plans should be updated within 24 hours of changes in a persons condition or of new needs arising. We found a care plan had not been updated more than 2 days after someone had had a catheter removed, to clarify their new needs and how staff should meet them. Information about this was found on other records, and staff we spoke with were aware. They were consistent in describing appropriate care and support now needed by the person concerned. They confirmed that they read care plans and/or had received verbal information about individuals current care needs on each shift they had worked. We noted some of this care was given during our visit. Both people we case-tracked were having their fluid intake and output monitored through keeping of fluid charts. The charts for one person had been completed regularly, showing they had drinks through the day. Records for the second person had been completed on previous days, with a reasonable intake each day. But during our visit nothing was noted on the chart except at 8am and 1pm. Thus by 2pm, the chart showed the person had only had 265mls to drink that day. When we asked staff in the afternoon about the persons fluid intake, one said they had not been told what the persons intake was so far that day although they had been told they were doing quite well. They Care Homes for Older People Page 4 of 13 thought 500mls would be an acceptable intake over the morning. There was no record of the persons intake in daily care notes for the morning, and no guidance in the care plan about the fluid chart or what intake was appropriate. However, the person looked hydrated; they said that staff kept telling them they had to drink although the person felt they drank enough. They had a clean glass with squash in it, within their reach. They confirmed this was their preferred drink (as shown in their care plan also), and we heard staff doing hot drinks rounds in the afternoon ask them if they wanted a cold drink instead of tea or coffee. Staff were able to describe signs of dehydration, but gave various suggestions for how much an individual should ideally drink in a day; they said they would tell senior carers if someone drank less than this amount. Food intake charts had also been kept recently for one person. We looked at some and found they had not been completed each mealtime. More recent daily care notes did not reflect the persons intake well either, although weight charts indicated the persons weight had been stable over a month, after a period of weight loss. We were told that food intake charts had just been stopped because the person had an increased appetite. When we met the person, they said they were feeling a bit off colour, later telling us they had not eaten much for lunch that day, and that a carer had also told them they were not eating much. Staff we spoke with told us colleagues on previous shifts would only report on someones intake if there had been a problem with it, so if nothing was said it would be assumed the person had eaten sufficient. However, they were not aware that the person might have eaten relatively little at lunchtime, and there was nothing in the persons daily notes for the day. Other conversations with staff working on the unit suggested they were not fully informed about people who ate in the dining room (rather than on the unit) as this person had done. The second person ate their meals in their room during our visit, because of recent ill health, and this change of dining arrangements wasnt reflected in their care plan. There was no nutritional needs care plan for them despite a recent needs assessment that said they had a minced diet and that they should be prompted to drink regularly, as well as a mental health risk assessment that identified they sometimes refused to eat or drink. There were no suggestions in care records as to this persons dietary preferences, which might help care staff if they had to encourage the person to eat, although we were told that kitchen staff had a list of peoples likes/dislikes. There were intermittent records of this persons intake in their recent daily records. When we asked staff about any resident who had a risk of choking, one staff member identified this person as needing a pureed diet. The persons care plan hadnt indicated what staff should do if the person choked. Another staff member said there was no-one at such risk. One person complained to us that their bottom was sore. Staff looking after them were not aware of this current problem for the person, but knew the person required pressurerelieving equipment, which we saw was in place. A care plan had been written, on the persons admission some months previously, for promoting skin integrity. This did not refer to a separate risk assessment which showed the person was at high risk of getting a pressure sore, whether district nurse advice was sought about this, or if any pressurerelieving equipment had been provided then. Advice was sought 3 months later when their skin worsened, although there was a delay in following this up when there was no response from relevant professionals initially. Soreness had been reported in the persons daily notes since, but not in the last week. A relevant skin cream chart in the persons bedroom had not been completed regularly. There was no evidence that a community nurse had checked the persons skin. Care Homes for Older People Page 5 of 13 Records and our observations showed some aspects of care required by these two people were well monitored, such as catheter care and functioning, with prompt involvement of relevant professionals as necessary. One had been referred to a dietitian as a result of monitoring of their weight. However, care planning and monitoring systems were not sufficiently robust to ensure some peoples health and wellbeing, because there were risks that their needs would not be met properly or consistently. When we checked training records to see how many staff had attended training on care planning - one of the providers action points - 14 of 70 care staff had attended training. The manager said training had been halted because the care documentation was being revised, but it was still included in new staff induction programmes. We have since been told that another 9 staff have undergone the training as part of their induction. We spoke with a care assistant who had had the training. They said it included identification of peoples care needs, and personalisation of care plans in order to move away from institutionalised care. We could see this approach reflected in the care records we looked at. The homes written policies and the action plan said that staff should print their name alongside entries in care records. One staff member we spoke with about this said they had been told to print their name as well as using a signature. But not all staff were doing this, with some records not allowing space for this to be done easily. We discussed other ways of achieving the required outcome (i.e. that it be clear who had made each entry in records) with the manager. The manager explained there was now a system established for storage of care records, so that they are kept as required by regulation. Staff had also had some training on the legal significance of such records. Minutes of a night staff meeting showed that the importance of fluid charts had been discussed, including legal aspects. All information and written records we requested during our visit were made available to us. The provider also made recommendations for improving communication - with relatives or other advocates of people who lived at the home, as well as within the staff team. The providers recommendation was that a staff member should be delegated to contact peoples families, and the staff member should be the persons keyworker. The homes guidance on the Keyworker role included only that they should ensure appropriate contact made with family, etc. if requested by the individual. We found evidence that next-of-kin or other advocates had been informed of significant events relating to individuals living at the home - such as accidents or changes in health. This information was kept on forms specifically for this type of record, with a prompt also for evidencing any contact with health professionals about the matter. We noted that staff had recorded when relatives had not been informed because the individual did not want staff to contact them. We also saw, in one case, that an advocates views had been communicated to the GP on the advocates behalf. We were told by care staff that all such communication was usually done by senior carers, at the suggestion of the keyworker. We saw that the home routinely recorded the wishes of individuals about their representative attending or being involved in reviews of their care plan. Such involvement was another opportunity for promoting communication with peoples Care Homes for Older People Page 6 of 13 families. One person we case-tracked had indicated they would like their relative to be involved. Yet there was no evidence that this had been acted on, with only the individual themselves having attended and signed care plan reviews. To monitor that all information was passed between shifts, a Handover book was now kept, with care assistants given increased responsibility for recording in it. We discussed with the manager the need to ensure that such records were kept in line with data protection guidance so that personal information about individuals was kept in ways that protected their privacy, etc. When we asked care staff whose responsibility was the giving of required care, they said they were - as individual staff - and that the seniors (who they handed over to, or reported to) had some responsibility. One said the seniors would ask them about specific matters or ask about anything unusual. The provider recommended that staff were allocated to work in an area of the home for a long period of time, to promote continuity of care for individuals. Rotas and staff indicated this was not happening. The manager said that allocation was attempted for a week, but recruitment had affected allocations for longer periods of time, because appropriate skill mixes had to be maintained also. A staff member told us that if someone living at the home with more complex needs got on well with a particular staff member, the staff member might be allocated to work in that area of the home for longer than otherwise was usual. Staff allocation sheets we saw during our visit showed some continuity of carer for individuals, over the week, achieved by staff working in pairs on the units, with an overlap of a staff member between pairs. Staff we spoke with confirmed they had never had to look after someone they knew nothing about. They had always had at least some information, through hand-overs which they said they had received every time they had started a shift, from the person themselves, from families, and/or from written records. One said they would always make sure they knew about the persons mobility and dietary needs, since the person could ring for assistance or staff would be giving out drinks and meals each shift they were on. Asked about getting advice, staff said there was good team-working, and they could ask their peers or line manager, besides reading the available care information. Keyworkers were also to be allocated from staff working in the area, to ensure they were involved in the care of the individuals they were keyworker for. During our visit, we noted keyworkers were on duty but not working in relevant areas. We were told this was difficult to achieve in practise, but as keyworkers were now responsible for updating the care plans of the people they were keyworker for, they made sure they kept up-to-date with the persons care. Guidance on the keyworker role said they were to be allocated pre-admission (and meet the individual if possible), or within 2 weeks of the persons admission. Someone we spoke with said they were cared for by lots of different staff, and they didnt know if they had a keyworker. However, we saw a file in the persons room with the name and a photograph of their keyworker. This was the new Welcome pack produced by the home. We had read a notice asking keyworkers to collect packs for their individuals, with an indication that they would go through the pack with each person. One staff member we spoke with thought the packs were useful, and that they had read the contents to people with visual impairments; they felt people now had something to refer Care Homes for Older People Page 7 of 13 to for themselves, or their families also had access to information about the keyworkers. Another staff member said that the two people they were linked to were self-caring so they didnt need much physical help, but the staff member popped in to see them regularly, or got messages that the individuals wanted to see the staff member. Minutes of a residents meetings included discussion of the Welcome pack and the keyworkers responsibilities. To improve outcomes for people living at the home, senior carers were to take more effective responsibility for the delivery of care. Thus they now rotated between working hands on and running the shifts. We saw this in practise during our visit, with a senior allocated as a floater, working alongside other care staff for a variety of possible reasons (to assess an individuals care needs, for staff training, etc.). The staff allocation sheet stated Please identify where to work regarding the floater, but this was not done in advance or retrospectively during our visit. However, the allocation record promoted continuity of care staff with individuals, and enabled monitoring of which staff were responsible for delivery of care to which people - for both informing or communication purposes as well as follow up of any care issues. An assistant home manager had been appointed to allow for extra clinical supervision. They have care experience and we met them walking around the home in a monitoring capacity, answering call bells as part of this and liaising with staff on duty about the support or care individuals needed during that time. The manager and another deputy, who are both nurses, had also worked shifts on the nursing wing, monitoring care there. Staffing levels had been increased recently, from 10 to 11 staff in the afternoons, with 12 care staff on in the morning, to look after 63 people. The care staff throughout the home were supported by a full team of domestic staff. Staff thought the increase had been made following a recent staff meeting, when they raised the matter of relative staff shortages - in that the needs of people living at the home had recently increased, so staff were finding it difficult to care for them properly. The manager told us the increase was because resident numbers had increased. One person we spoke with said the staff were a little bit rushed at times and occasionally told them there were staff shortages, but they felt they generally got good treatment. They had a call bell within reach; they said they didnt always get a prompt response. We noted this person sometimes needed help from 2 staff, with time taken to get a second staff member on such occasions. A second person who felt their call bell was answered sufficiently quickly needed help from only one staff member. People told us that agency staff were used occasionally. Rotas for 2 recent weeks showed agency staff were required for 7 shifts one week (working mostly on the nursing wing), with 4 shifts covered by agency staff the following week - a very small proportion of the total staff shifts required each week. Although the home had received a copy of the providers investigation into the complaint, the manager had not seen the action plan or recommendations arising from the investigation prior to our visit. The manager confirmed she had more support currently, through weekly contact with a regional manager who is otherwise available for advice. We read some of the providers own recent monthly reports on the home, written following unannounced visits that are required by regulation. These showed, among other things, that the homes own care plan audits had been checked, with some shortfalls identified and some remedial action taken subsequently by the home. Care Homes for Older People Page 8 of 13 We have not received any other complaints about the home in the last 12 months. Training records showed the majority of staff had attended training on Customer care in recent months. Staff we asked about this said the training had included dealing with complaints. The manager had also undertaken similar training. We looked at the homes records of complaints. We saw peoples concerns had been recorded, with action taken to try to address them. This included meeting with the complainant to discuss the issues, and with dates agreed for reviewing the situation to monitor progress in addressing their concerns. Because of our findings, we will bring forward the key inspection for the home to monitor the homes action taken to address the requirements made in this report, whilst inspecting all the core National Minimum Standards. What the care home does well: What they could do better: 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 9 of 13 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 38 13 4 (c) You must ensure that unnecessary risks to the health or safety of people living at the Home are identified and so far as possible eliminated. This refers to ensuring that all COSHH items are kept securely stored. NOT INSPECTED ON THIS OCCASION. 26/07/2008 Care Homes for Older People Page 10 of 13 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 7 14 You must revise the 20/12/2009 assessment of each persons needs whenever their circumstances, condition or needs change So that the individuals curent needs are clearly identified, providing a good basis for their care plan. 2 7 15 You must revise and update - 20/12/2009 with sufficient detail - each persons care plan when their needs assessment is revised So that there is a current and precise care plan for each person as to how their individual health and welfare needs are to be met. 3 8 12 You must ensure the home is 20/12/2009 managed so as to promote and make proper provision for the care, health and welfare of each person who lives at the home, particularly with regard to effective systems to ensure that each person living at the Page 11 of 13 Care Homes for Older People 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 home receives the care they need, especially regarding their diet, drinks and pressure area care To ensure that peoples individual health and welfare needs are met. 4 33 24 You must establish and 20/12/2009 maintain effective systems for evaluating the quality of the services provided at the care home, particularly regarding the providers own action plans So that any shortfalls identified in the service provided to people living at the home are addressed. 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 Care Homes for Older People Page 12 of 13 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 13 of 13 - 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!