Inspection on 04/11/09 for Cavendish Care Home

This is the latest available inspection report for this service, carried out on 4th November 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 but made no statutory requirements on the home.

Other inspections for this house

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

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Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Cavendish Care Home 301 Stroud Road Gloucester GL1 5LF Lead Inspector Sharon Hayward-Wright Key Unannounced Inspection 4th November 2009 09:45 DS0000072774.V378283.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought 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. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) 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. www.cqc.org.uk Internet address Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cavendish Care Home Address 301 Stroud Road Gloucester GL1 5LF 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) 01452 521896 01452 307399 Cavendish Care Home Ltd Mrs Pamela Ann Teemul Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (24) of places Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) 2. Dementia aged 65 years or over on admission (Code DE(E)) The maximum number of service users who can be accommodated is 24. 6th June 2009 Date of last inspection Brief Description of the Service: Cavendish Care Home is a large extended house situated on the outskirts of Gloucester City offering personal care to those who have dementia. The Home is on a main bus route and has off road parking to the front and rear. There is a small enclosed back garden and a patio area to the side of the property. Internally accommodation is laid out on two floors with a passenger lift accessing the first floor. There are two lounge areas with combined dining areas, and a small sitting area by the front door serves as a third. Each of the single and double bedrooms has a wash hand basin and is near to communal toilets and bathrooms. Four new bedrooms have added to the upstairs and they provide en-suite facilities. The current fees at Cavendish at the time of writing this report range from the Local Authority funded rate of £486.25, up to £667.01. People who fund their placements privately have additional service included in the fees and these include toiletries, newspapers and chiropody. People who have their care funded by Community and Adult Care Directorate are able to arrange on an individual basis different payment options for these additional services. Information about the home is available in the Service User Guide, which is Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.2 Page 5 issued to all prospective residents. The home does not display its previous inspection report, although does display a notice confirming it is available, and inviting people to request a copy to read if they wish. Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection was carried out by one inspector over two days in November 2009. We did not request an Annual Quality Assurance Assessment (AQAA) prior to this inspection as we received one prior to the last key inspection in June 2009. We looked at other information we have received from or about the service from other stakeholders. This should include where the home notifies us of any incidents that affects the well being of people who use the service. We looked at a number of systems the service has in place to include care records, activities, staff supervision and training, complaints and medication. We spoke to people where able to gauge their views on the service provided. We also spoke to staff and observed interactions between staff and people who use the service and the results of all these have been used in this report. At the inspection in June 2009 we rated this service as ‘0’ stars which meant ‘poor’ quality outcomes for people who use the service. Following this inspection we received an improvement plan detailing how the Registered Person was going to address the shortfalls. We undertook a random inspection in September 2009 and found that a number of improvements had taken place. At this key inspection we found that the service has continued to improve which is excellent. The home must now continue to maintain these standards and address the areas we have highlighted at this inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.2 Page 7 People who use the service have access to a varied diet and are able to make choices regarding their meals. The standard of the food we observed was very good. We also tasted a meal and found it to be very well cooked and delicious. The kitchen has been awarded ‘4 stars’ by the local Environmental Health Department which is very good. People are not admitted to the home without first having their needs assessed and assurances that these can be met. Some activities are being provided early evening to help people to settle prior to them going to bed which is good practice. The home exceeds the recommended 50 of care staff with or working towards an NVQ 2 or above in Health and Social care. What has improved since the last inspection? Following a review of the care plans since the last key inspection, a new format has been introduced. We found that ongoing assessments of needs were much more detailed and contained people’s choices. Care plans provide staff with clear directions on how to meet people’s needs. Risk assessments are more detailed and more pertinent to the person and the outcomes are more achievable by the care staff. People who use the service are having more input from external health care professionals which is excellent. Monitoring of people’s weight has greatly improved and when people are identified as being at risk due to weight loss the appropriate health care professionals have been involved in their care. The use of seat covers has ceased in the communal areas unless requested by a person as this is institutional practice. We identified a number of environmental issues at the last key inspection and they have been addressed. We also raised concerns about unpleasant odours, but these have now reduced and the home is working hard to combat these. A change to the staffing numbers and allocations has resulted in a new member of staff being appointed to serve breakfasts and this has resulted in people now receiving their breakfasts at a more reasonable time. Some changes to the staff finishing times have also been made to make sure there are enough staff on duty to meet people’s needs. Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.2 Page 8 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Cavendish Care Home DS0000072774.V378283.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 Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A system is in place to make sure prospective people undergo an assessment of their needs prior to admission to enable the home to decide if they can meet their needs. EVIDENCE: The pre admission assessments of three people admitted to the home since the last key inspection were examined. Since the last key inspection the home has changed the care planning format and is using a new pre admission assessment form. We were able to see evidence that two of the assessments were completed prior to admission but one was not dated or signed by the person completing it. The Registered Manager said that an assessment was Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.3 Page 11 undertaken by another member of staff. We found that from speaking with the Registered Manager she was aware of more information about each person than what was written on the pre admission assessment. Some of this information is vital and needs to be included in the written assessment. One person was transferred from another care home but the Registered Manager was not able to find any written information about this person from them. One person was funded by the local Community and Adult Care Directorate (CACD) and we were shown copies of their care plans completed by a Social Worker prior to this person being admitted to the home. The Registered Manager needs to look at ways of including in the pre admission assessment the information she was able to tell us verbally. At the last key inspection we found that pre admission assessments contained more information about people’s care needs. We were shown copies of the letters that are sent to prospective people following an assessment of their needs to confirm the home can meet their needs. We were unable to discuss with people their admission to the home due to their medical diagnosis. Intermediate care is not provided at Cavendish Care Home. Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.3 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to the care planning system and staff now have clear directions to follow when meeting people’s needs. People are having a greater input from external health care professionals and people’s health needs are being monitored more effectively. Some improvements are needed in relation to some of the medications systems to make sure people are not placed at unnecessary risk. EVIDENCE: Following the last key inspection the home has changed the care planning format. The improvement plan we received said that all people would have their care records transferred on to the new format. We found that this had been achieved at the random inspection we undertook in September this year. The home is registered to care for people with dementia and we found that at the last key inspection each person had a ‘whole picture plan’ and ‘strength Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.3 Page 13 assessment’ which provided information about people’s mental health. However these were no longer in place at the random inspection and we discussed with the Registered Manager that these provided valuable information. Following the random inspection the Registered Manager was going to add these to people’s care records, this is still ongoing. We examined a number of people’s care records and undertook a case tracking exercise on several of these. This included examining care records, speaking to the person if able about their care, speaking to staff and observing them interacting and caring for people. We found that people had detailed assessments of needs in place that included people’s choices which is an improvement on the last key inspection. Reviews of these are also taking place. The vast majority of care plans contained more details including people’s choices and clearly directed peoples care. Again this is an improvement from the last key inspection. Reviews were also in place. At the random inspection we found that some people who were diabetics required more information in their care plans and this had been addressed. The care planning format used by the home has daily ongoing records completed by care staff. The recording of the frequency of bathing or showering needs to be reviewed as in some cases the last documented bath or shower appeared to be many weeks prior to this inspection. At the last key inspection we found that people’s weights were not being monitored and we identified a number of people with weight loss. At the random inspection we found that the home had greatly improved their monitoring of this. We found risk assessments in place for nutrition and people were being weighed dependent on their assessed needs. The staff had involved a number of health care professionals to include GP and a Dietician, which is excellent. We found at this inspection the monitoring of people’s weight is continuing and we found a number of people have put on weight. Where people are losing weight this is being more closely monitored and the appropriate health professional being kept up dated. One person needs to have the advice of the Dietician included in their care plan and one person needs to have a care plan devised regarding the management and ongoing monitoring of their 10kg weight loss. At the last key inspection we identified concerns about people having their needs met in relation to pressure area care and toileting. In relation to pressure area care of one person it needs to be documented in their care plan about how the care staff are meeting this need. The care staff were very clear about how they manage this need but the care plan lacked this information. Regarding toileting of people, the one person who this mainly related to has since left the home and the care staff said they have a regime in place for people. We would recommend that for people who are not able to mobilise that staff consider changing people positions frequently and not just when assisting them to the toilet. Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.3 Page 14 We discussed with the Registered Manager that we had observed that a number of people who were assisted by the staff to wash and dress had not had their hair brushed. We also found that several people had dirty and long nails. The Registered Manager said that some people refused this care. If this is the case then it needs to be clearly documented and the care staff should approach them again later. One person did have their nails cut during the inspection. Otherwise people were tidily dressed. Since the last key inspection we found that people are having more access to health care professionals and these include; GP, Community Psychiatric Nurses, Chiropodist, Optician, Dentist, Dieticians and Speech and Language Therapist. This is excellent for people who use the service. We found that one person who was visited by the Speech and Language Therapist had information devised by them in case this person was admitted to hospital and for the care staff to use in the home. Again this is excellent use of external resources by the care staff in the home. The systems the home has in place for the management of medications were examined. We observed at different times during the inspection the administration process and safe systems were used however when taking the medication to the person best practice is to take the medication administration record (MAR) as well. The medication administration records were checked and we found several gaps in the recording of medications that were due to be given. Accurate records of all medications administered must be kept. Records were in place for medication received into the home and where required returned to the pharmacy. We audited a number of medications including checking how many medications have been given against how many were received. We found three discrepancies. For instance, care staff had signed for too many tablets, tablets could not be accounted for and the Registered Manager said she had signed in the wrong place. The last incident needs to be reviewed by the home as the person receives alternating doses of medication each day and if this is not handled correctly could place them at risk of harm. Auditing of the medication systems used would have picked up these incidents. Dates of opening were observed on boxed medication, eye drops and liquid medications. Since the last key inspection the home has reviewed the storage of prescribed creams and these are now being stored securely. Hand written entries should be checked and signed by a second member of staff for safety. The home has also started to monitor the temperature of the room where medication is stored and it was found that on some occasions the temperature exceed the recommended limits set by the manufacturers. The temperature of the medication trolley is also being monitored. The home has one person receiving medication that needs to be stored as controlled medication. A system is in place to monitor its use, but the home also needs to consider frequent documented auditing of this medication. Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.3 Page 15 The homely remedy policy needs to be reviewed as it was last signed by people’s GP’s in 2007 and reviewed by the home in 2008. The Registered Manager said that only senior care staff administer medication and they receive external medication training. Consideration should also be given to the Registered Manager checking the competencies of each member of care staff who admisnter medications. A list of medications and side effects are available for staff. The home has where able incorporated some of the principles of the Mental Capacity Act 2005 guidance into medication systems by asking people for example where they would like their medications administered etc. We observed staff speaking to people in a respectful manner. We found that following the last key inspection seat covers are no longer used in the communal areas, except in the case of one person who the Registered Manager said likes to have one. We also found that aprons are no longer being stored on the table in the front lounge. We did observe people wearing them but we were not in the room to observe staff offer them to people. We did observe a number of people remove them once they had eaten their meal. This practice is much improved. Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.3 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to an activities programme that is based on their needs and abilities. Improvements to the staffing arrangements have meant that people receive their meals in a timely fashion and staff are now assisting people to make more choices about their daily lives. EVIDENCE: At the last key inspection we examined activities in detail. At this inspection we followed up on several areas that needed some clarity. The home’s activities coordinator now works three half days per week and in between her visits the staff provide activities once they have completed their care duties. At the last key inspection the Registered Provider said he has plans to increase the activity hours which would be beneficial to people who use the service. External entertainers visit the home and music and movement was taking place on the first day of the inspection and people were enjoying this. A poster was seen advertising a singer who is due to be at the home in December. An Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.3 Page 17 activity file was seen at the last key inspection and this lists all activities provided to include external entertainers. The Registered Manager said they still continue to have some early evening activities and these usually take place about twice a month and she said people enjoy these. At the last key inspection the Registered Manager said that Church services take place but a Regulation unannounced 26 visit which was completed on behalf of the Registered Provider said that they had ceased. The Registered Manager said at this inspection they provide communion for all faiths once a month. She also said the people who use the service have not requested to visit a place of worship. One person is a spiritualist and they have their own arrangements in place. At the last key inspection we spoke to a number of visitors to the home and they confirmed visiting is not restricted and that the staff make them feel welcome. At this key inspection we observed that people had a number of visitors at different times of the day. People who use the service are not able to manage their own finances so this would be undertaken by family or representatives on their behalf. We saw evidence that some people have a Lasting Power of Attorney in place. Information about advocacy is provided in the main entrance of the home. We observed in a number of rooms people’s personal belongings on display. At the last inspection we had some concerns that people were not being offered choices and for some people due to their medical condition staff would have to make choices for them. We did observe some people being offered choices especially with the meal provision and drinks. We also observed care staff asking people if they would like to go to the toilet and asking people where they would like to sit. The Registered Manager said staff now ask people if they would like to wear an apron, however we did not witness this as people were already eating their meals when we observed a mealtime. At the last inspection we undertook a brief inspection of the kitchen area as the home has been awarded ‘4 stars’ from the local Environmental Health Department (EH) which is excellent. Records were also seen of health and safety checks but records needed to be maintained of the type of soups offered and sandwich fillings for each day. We were told this has been addressed. Menu boards are on display in both communal areas and this includes the alternatives that are also on offer. In the dining room table cloths and salt and pepper are on the tables for people to help themselves. At the last key inspection we had concerns about the timing of people receiving their breakfasts as care staff were having to assist people with personal care and then serve people breakfasts. Following this the Registered Provider appointed a member of staff purely just to serve people with breakfasts. At the random inspection and this key inspection we found that people do not have to wait for their breakfasts. The issues with uncovered food Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.3 Page 18 going cold has now stopped as the breakfast member of staff brings them direct from the kitchen area covered. This is much improved. The Registered Manager and other care staff spoken with said having this extra member of staff to just serve breakfasts has made a impact on people’s lives and allows them more time to assist people with personal care. The breakfast assistant also provides people with drinks and snacks later in the morning. People are still offered a cooked breakfast each day and they are able to choose what they would like. This is good practice. We observed a mealtime and observed staff assisting people discreetly and they were always sitting down next to the person. We asked three people if they enjoyed the meal and two people said no but continued to eat it, the other person said the food is very nice. All the care staff help to serve meals and this meant that at times the front lounge was left unsupervised. We witnessed several people not eating their meals and one person was asleep. When staff came back into the room they did encourage people to eat their meals. One person did not want to eat their meal and one member of staff went to the kitchen and obtained a different meal for this person based on their choice and they did eat some of this. This is good practice. We tasted the meal on the second day of the inspection and we were offered the same choice as people who use the service. We had home made cottage pie and vegetables; the meal was very tasty and very well cooked. People who required a soft or liquidised diet had all sections of the meal liquidised separately. We observed people being offered hot and cold drinks throughout the day as well as snacks. On one of the afternoons we asked one person why they were not having cake with their tea and they said they prefer biscuits. The staff had made sure they were offered the same choices as other people. Consideration needs to be given to improving the staff supervision in the communal rooms during mealtimes. Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service and their representatives are able to voice any concerns they might have and have access to a complaints procedure. Systems are in place to help prevent people from possible risk of harm or abuse. EVIDENCE: The home has not received any formal complaints since the last key inspection. Prior to the random inspection in September the home had contacted us about several concerns that had been raised by neighbours. The Registered Manager has investigated these and has responded to people who raised the concerns. Actions are being put in to place to address these. A copy of the home’s complaints procedure is on display in the entrance hall of the home and this has been printed in a larger print. The Registered Manager says she operates an ‘open door’ policy and encourages relatives/representatives of people to speak to the staff if they are unhappy about anything. The home has polices in place in relation to whistle blowing and protection of vulnerable people and this policy also includes information about abuse as these were seen at the last key inspection. The home still needs to have a policy for the management of violence and aggression. The vast majority of staff have completed the ‘Alerters’ guide training provided by the local County Council, with only three new staff needing to undertake Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.3 Page 20 this training. The Registered Manager provided evidence at the last key inspection to show she has completed the one day ‘enhanced’ adult protection training provided by the local County Council as well as one other member of staff. No people who use the service have been referred to the local safeguarding unit at the County Council. The home has a policy in place for Deprivations of Liberty but they have as yet to devise one for the Mental Capacity Act 2005. The Registered Manager said all care staff have completed the local County Councils training in Deprivation of Liberty and Mental Capacity Act 2005 and we saw several staff members certificates. The Registered Manager said that no people are subjected to Deprivation of Liberty and no ‘best interest meetings’ have taken place for people. Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.3 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Cavendish Care home is not a purpose facility but some adaptations have been made to help meet people’s needs. However improvements are needed to some infection control procedures to make sure people and staff are not put at unnecessary risk. EVIDENCE: A tour of parts of the environment took place with a number of rooms belonging to people viewed. Cavendish Care Home is not a purpose facility however some adaptations have been put in place and these include assisted bathing facilities. As the home is registered to care for people with dementia signage is in place to direct people to the toilets and communal rooms. The toilet doors have all been painted the same colour and downstairs in one of the corridors fixed to the wall is a board with a selection of handles on for people Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.3 Page 22 to touch as they walk past. Four bedrooms upstairs provide en-suite facilities. In places the décor looks tired especially compared to the newer part of the home and in one upstairs bathroom we found that the wall paper is peeling off the walls. We would recommend that a redecoration programme is put in place. The Registered Provider said they are looking to change the main entrance of the home back to original entrance once it redecorated and the door furniture altered. At the random inspection in September we found that on entering the home on the first day the entrance area was very odorous, however at this key inspection we found that this has greatly improved. The Registered Provider said they have undertaken a lot of work to try and rectify the situation. A new domestic has started at the home but they were on annual leave and other staff were undertaking the cleaning duties as extra to their normal job roles. The overall cleanliness had improved since the last key inspection but this needs to be monitored by the Registered Manager especially the toilet areas. At the last key inspection we identified a number of areas that required improvement and these have now all been addressed. However we would suggest that a member of staff is allocated to monitor that all toilets have paper hand towels in place as we found several that had run out. The Registered Manager informed us that the home has purchased six new profiling beds which is excellent for both people who use the service and staff. Since the last key inspection the Registered Provider has addressed the issue with the television reception in the rear lounge. People spoken with said it much better. We examined the laundry area in detail at this inspection. Care staff do the laundry as part of their job role. Two washing machines are provided and one has a sluicing programme. Two dryers are also available. A procedure is in place for managing soiled linen. The room is small and cluttered in places and one of the bins does not have a lid on it. We would recommend that this room is reviewed to see if any changes can be made. Care staff need to use the toilet sluicing facility to clean and empty commode pots but this is in the corner and the bin for disposing of continence products is in front of it. We discussed how care staff need to access this room when emptying and cleaning commode pots for people who have bedrooms upstairs. The Registered Provider said they are now going to look into fitting a commode pan washer upstairs, which would greatly reduce the risk of cross infection. Protective clothing to include gloves and aprons are provided for staff and we observed staff using them. Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Changes to the staffing numbers and allocations have improved peoples lives by making sure that they receive personal care and meals at more suitable time. Unsafe recruitment practices means that people who use the service are not always safeguarded against possible risk of harm. EVIDENCE: The duty rotas were viewed with the Registered Manager as changes to the way the staff are allocated has taken place following the last key inspection. At the random inspection we were able to see that the additional member of staff allocated just to serve breakfasts and drinks has greatly improved the mealtime provision. Other changes have also taken place with the allocation of staff and shift patterns. The improvement plan the home sent to us after the last key inspection said that some care staff are no longer finishing work at 11am but staying on until 1pm and in the evening all staff now finish at 8pm. We were able to see these changes on the duty rotas. The Registered Manager said the staff work well together and they will always try to cover any shifts that are vacant, however agency staff have had to be used to cover some shifts as two members of staff contracted swine flu. Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.3 Page 24 Staff spoken with said it is a nice place to work and they work well as a team. They said they are well supported by the Registered Manager and find she is very approachable. At the last key inspection the Registered Manager confirmed that the numbers of staff who have an NVQ 2 or above in Health and Social Care or who are due to start this training exceeds the recommended 50 of care staff. We looked at three recruitment files of staff that have started work at the home since the last key inspection. We found that all the required pre employment checks were in place except two staff did not have a full employment history therefore the gaps had not been explored. Some had used years and not provided more specific dates. We could not find evidence that all the written references had been received prior to the members of staff starting work. For one member of staff it was difficult to read who had completed their references. We did see that the Registered Manager had also obtained verbal references for two staff members which is good practice. The Care Home Regulations 2001 states “it is the responsibility of the Registered Persons to satisfy themselves of the authenticity of the references.” At the last key inspection we found that employment histories were not being obtained in full. All three members of staff had a POVAfirst check in place prior to starting at the home and a full Criminal Records Bureau Disclosure (CRB). However we found that one member of staff was not supervised for the whole time whilst the home was waiting for return of the CRB, this is unsafe practice. All three new staff started work on the same day. This is not good practice as it can be disruptive to people who use the service and new staff require time to learn about the service and get to know people and other staff. Following the last key inspection the home sent us their improvement plan which stated a “staff recruitment audit will monitor that all relevant information and documents have been received prior to commencing employment”. This clearly has not taken place. The home must improve their recruitment practices to make sure people who use the service are not placed at unnecessary risk. From the 12th October 2009 changes have been made to the way the home’s check if staff are suitable to work with vulnerable adults. We would strongly suggest that the home finds out about the Independent Safe Authority (ISA) and the Vetting and Barring Scheme. Since the last key inspection the home has changed their induction training. New staff now attend a 3 day training course provided by an external trainer. Each member of staff is given a booklet based on the Skills for Care common induction standards. The Registered Manager said she and other senior care staff would sign off each section once completed by the new member of staff. We saw evidence that staff are supervised as part of their induction training. Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.3 Page 25 At the last key inspection we saw a number of training certificates for in house training and we were concerned that some staff have not received moving and handling training. This has now been addressed and plans are in place for further moving and handling training that is provided by an external training provider. The Care Home Support team are also providing training for staff in a number of areas to include dementia, care planning, the use of the MUST tool and accountability. We also expressed concern about the lack of first aid awareness training, again this has been addressed and more training is planned for staff who did not attend the first course. The Registered Manager has a matrix in place for staff training and is aware that she needs to monitor when training and updates are due for staff in both mandatory subjects and other area pertinent to the needs of people who use the service. Staff confirmed that training is provided. Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.3 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to the way the home is managed and the introduction of auditing have helped to make sure the service is now run in the best interests of people who use it. EVIDENCE: Since the last key inspection there have been no changes to the management of the home. The Registered Manager has been working at this home for about 16 years and has many years experience in looking after older people. She keeps herself up to date with training and we saw her training record at the last key inspection. The Registered Manager needs to consider undertaking a management training course. Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.3 Page 27 Staff spoken with felt the Registered Manager was very supportive and approachable and they would tell her if they had any concerns about the service. We did not request an Annual Quality Assurance Assessment (AQAA) as these are required once a year and the home provided one for the June 2009 inspection. However the home’s list of policies had a number of omissions and these included moving and handling, management of aggression and first aid. We were not shown evidence that these have been put in place as yet at this key inspection and we would strongly recommend that this is addressed. At this key inspection we were looking at what auditing the home has put into place. The Registered Manager was able to show us audit forms that have recently started and these include care plans. In the care plan audit the Registered Manager is looking at a number of areas to include risk assessments, peoples weight and any wounds or pressure sores. A new accident audit has also just started. Regulation 26 visits where the Registered Provider or a representative on their behalf visits the home monthly unannounced and undertakes an audit are taking place. We would like to continue to receive copies of these visits to monitor the progress of this service following the poor rating it received at the June 2009 key inspection. The Registered Manager said that equality and diversity training is planned for staff and a policy is going to be devised. The home was able to demonstrate at the last key inspection that they have a safe system in place for the management of people’s monies. At the last key inspection the Registered Manager needed to implement a staff supervision programme. This has now started. The Registered Manager has undertaken training in appraisal and supervision and there are plans to send the senior care staff on this training. We randomly selected a number of staff files and saw their supervision records. The AQAA we received prior to the key inspection in June 2009 contained some information about the servicing of certain equipment in the home and other records were seen at the last key inspection. Records relating to monthly water temperature checks and checking of fire equipment were seen at the last key inspection. We did not examine the fire risk assessment at this key inspection as it was in place at the last key inspection. At this inspection we asked the Registered Provider to look at the systems they have in place to prevent Legionella. They are looking to put a risk assessment in place and to make sure the checks they are undertaking are sufficient. Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.3 Page 28 Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.3 Page 29 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 4 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 2 X 2 Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.3 Page 30 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 OP29 Regulation 19 Requirement In circumstances where new staff commence employment pursuant to the receipt of a Criminal Records Bureau disclosure the registered person must: Appoint an appropriately qualified and experienced ‘staff member’ to supervise the new worker, pending receipt of a satisfactory disclosure So far as is possible, ensure that the ‘staff member’ is on duty at the same time as the new worker; and Ensure that the new worker does not escort service users away from the care home premises unless accompanied by the ‘staff member’. This is to ensure that only suitable people are employed to work with vulnerable residents and to promote their safety. 2. OP29 19 The registered person must make sure that all the required recruitment checks take place prior to a new member of staff DS0000072774.V378283.R01.S.doc Timescale for action 30/12/09 30/12/09 Cavendish Care Home Version 5.3 Page 31 starting work at the home. This will help to safeguard people who use the service. This requirement remains outstanding since the last key inspection. Timescale 30/06/09. 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. 2. 3. 4. 5. Refer to Standard OP9 OP9 OP29 OP29 OP38 Good Practice Recommendations Hand written entries should be checked and signed by a second member of staff for safety. The home needs to make sure medications are stored at the recommended manufacturers’ temperature and maintain records to demonstrate this. References should be date stamped when received to provide evidence that they were back prior to the new member of staff starting work. The home should not start more than one new member of on the same day as this is disruptive to people who use the service and new staff need time to settle in. The home should devise a risk assessment for Legionella and check with the appropriate authorities that the checks they have in place are sufficient. Cavendish Care Home DS0000072774.V378283.R01.S.doc Version 5.3 Page 32 Care Quality Commission Care Quality Commission South West Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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). 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