Inspection on 01/06/06 for Culm Valley Care Centre

This inspection was carried out on 1st June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Culm Valley Care Centre 09/10/08

Culm Valley Care Centre 15/04/08

Culm Valley Care Centre 09/08/07

Culm Valley Care Centre 26/10/06

Culm Valley Care Centre 13/09/05

Culm Valley Care Centre 26/04/05

Culm Valley Care Centre 23/11/04

Culm Valley Care Centre 30/06/04

Culm Valley Care Centre 25/03/04

Culm Valley Care Centre 13/01/04

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Culm Valley Care Centre 10 Gravel Walk Cullompton Devon EX15 1DA Lead Inspector Rachel Doyle Key Unannounced Inspection 10:30 1st June 2006 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 Culm Valley Care Centre DS0000037291.V289757.R01.S.doc Version 5.1 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. Culm Valley Care Centre DS0000037291.V289757.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Culm Valley Care Centre Address 10 Gravel Walk Cullompton Devon EX15 1DA 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) 01884 33142 01884 32846 Ashdown Care Limited Care Home 56 Category(ies) of Old age, not falling within any other category registration, with number (56), Physical disability over 65 years of age of places (56) Culm Valley Care Centre DS0000037291.V289757.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Registered for up to 6 people Intermediate Care (50 years and above) The maximum number of placements including those of the named service users will remain at 56 This variation allows for the admission of one named person under the age of 65 in the category PD Physical disability. On the termination of the placement of either of the named service users the Registered Person will notify the Commission and the particulars and conditions of this registration will revert to those held on the 5/01/04 or as appropriate. To admit one named person outside the categories of registration in the category DE [E] as detailed in the notice dated 26th January 2006 15th January 2006 5. Date of last inspection Brief Description of the Service: Culm Valley Care Centre is a 56 bedded home over two floors, which provides nursing care for people over the age of 65 and intermediate care under a GP scheme alongside the ReAblement team of healthcare professionals. The Home provides convalescent, terminal, respite and continuing care. It is situated a few minutes walk from high street amenities in Cullompton and just behind St Andrews Church. There are 3 day/quiet rooms, 44 single rooms, most with ensuite, and 6 double rooms. There is plenty of car parking and a spacious and level access landscaped garden with patios accessed from the first floor corridor and some residents’ rooms. The average cost of care is £354-630 per week at the time of inspection. Additional costs, not covered in the fees, include chiropody, hairdressing and personal items such as toiletries and newspapers. Previous inspection reports are available in the reception area. Culm Valley Care Centre DS0000037291.V289757.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors undertook this unannounced inspection over a period of eight and a half hours. There were 46 residents living at the Home. During the inspection the inspector’s case tracked 6 residents, which helps us to understand the experiences of people using the service. A number of other residents were met and spoken with during the course of the day. The inspectors also spent a considerable time observing the care and attention given to residents by staff, with one inspector taking lunch with 16 residents in the dining room. Several staff were spoken with during the day, including care staff, nursing staff, ancillary staff and the acting manager. Three relatives were also spoken with during the inspection. Prior to the inspection surveys were sent to residents to obtain their views of the service provided; 12 were returned, some helped by relatives and one had only been at the home for 4 days. Comments were in the main satisfactory with the majority of the respondents confirming that they ‘usually’ receive the care and support they need. 6 residents did not feel that they had had enough information or seen a contract prior to moving in. One had had no prior warning until the day. 48 staff were sent surveys in order to hear their confidential views; 11 were returned. The inspectors toured the premises and a sample number of records were inspected which included care plans, medication records/procedures, staff recruitment files, training, service and maintenance certificates and fire safety records. The acting manager had completed a pre-inspection questionnaire and the inspectors appreciated the preparation undertaken by the manager to assist with this inspection. Finally the outcome of the inspection was discussed with the acting manager. It is noted that management have been working hard to make improvements since the last inspection. Several organisational changes have been made and staff are getting used to their different roles. The acting manager made it clear that they wished to work with CSCI to continue to improve and put the residents’ at the heart of this work. All residents spoke well of the attitudes of the staff as they carried out their work and felt that they were treated with respect in a kind and caring manner. If the Home continues to improve CSCI are confident that the Home will achieve adequate status at the next inspection. What the service does well: Culm Valley Care Centre DS0000037291.V289757.R01.S.doc Version 5.1 Page 6 Measures are in place to ensure that residents’ personal monies kept by the home are correctly managed. The manager felt supported by the provider to follow the maintenance programme and the grounds and front patio are looking especially good and some residents were enjoying the fine weather and flowers. All residents said that they benefited from caring staff who assisted them gently and with respect. One relative said that a resident received ‘perfect care’. Relatives always felt welcomed into the Home and were able to visit at any time. Health Professionals in general felt that the Home worked in partnership with them and was satisfied with the overall care. The Home produces a comprehensive Statement of Purpose and Service Users’ Guide, which is kept in residents’ rooms. There is also a good activity newsletter. Recording of medication is good and recording sheets are clear and used well. What has improved since the last inspection? What they could do better: The Home must meet standards relating to maintenance and recording of adequate assessments, care plans and other records. The Home must not admit residents out of the registered categories ie Dementia and Mental Health. The Home must ensure that care needs are met and in a timely manner bearing in mind the residents’ wishes. The Home must ensure that medication is administered safely at all times. Culm Valley Care Centre DS0000037291.V289757.R01.S.doc Version 5.1 Page 7 The Home must fully maintain and record all concerns/complaints in the complaints book showing clear action taken and follow up and communicate this to the complainant. Activities must be offered which meet all residents social and leisure needs. The Home must ensure that staff on duty have the necessary skill mix to deliver care meeting residents’ needs. Recruitment records must be robust. Manual Handling training records should be kept clearly up to date. Improvements could be made to the back patio making it safe and pleasant for residents who have access. Information must be gathered to ensure that residents’ spiritual needs can be met by the appropriate people. Improvements should be made to ensure that all residents can make their views known within the quality assurance system. Meals should be offered in a more congenial setting ensuring that all residents have the opportunity to make choices and that satisfaction is monitored at the time by care staff. It is noted that the cook will be conducting a monthly audit. 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. Culm Valley Care Centre DS0000037291.V289757.R01.S.doc Version 5.1 Page 8 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 Culm Valley Care Centre DS0000037291.V289757.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information provided to prospective and current residents is adequate. The assessment information for some residents is poor and inconsistent potentially putting residents at risk and could result in needs not being met. EVIDENCE: Guides to the home are kept in each of the bedrooms and given on admission. There is a month’s trial period. The residents spoken with were unaware that they had a contract or terms and conditions of occupancy but this is not unusual given the needs of these residents. This was also reflected in the comment cards. Records did not state who the Home had discussed these with on behalf of the resident. The Home visits residents in hospital or home prior to admission to assess them and talk to relatives. One letter was seen which confirmed that the Home could meet a resident’s needs. Culm Valley Care Centre DS0000037291.V289757.R01.S.doc Version 5.1 Page 10 Needs assessments were variable. One was excellent, the other five lacked in depth information and had not been translated fully into a care plan. One resident had been identified as being at risk of choking by health and social care professionals but this was not mentioned in the Home’s care plan and staff were unaware of this. Two assessments clearly identified primary mental health needs, which do not reflect the Homes’ Statement of Purpose. This home is not registered to provide this type of care. This has been discussed with management and the Home are aware that an application must be received by CSCI in order to rectify this as soon as possible to ensure that the residents’ needs are met. The Home provides intermediate care in three allocated beds under a GP scheme with input from the Re-Ablement team. Culm Valley Care Centre DS0000037291.V289757.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Whilst the ability of this home to meet the health and personal care needs of the residents has and continues to improve, this area of care remains poor. The management of medication in the service is adequate but could place residents at risk of harm. EVIDENCE: All six residents case-tracked had an individual plan of care. However, the quality of information contained within these was variable. Two were excellent with assessments based on best practice, clear instructions on how needs are to be met and regular reviews. Entries included sound reasoning for actions taken and there was evidence of person centred care. One example of this is ‘ensure food is pureed as X gets tired of chewing and gives up’. This person was assisted to eat lunch, was offered and took drinks regularly and was put to bed after lunch for a rest and then helped to get up again and sit in the lounge. Another had good information about dementia care, especially spiritual needs and it is commendable that progress was recorded relating to increased independence. However, details relating to a Culm Valley Care Centre DS0000037291.V289757.R01.S.doc Version 5.1 Page 12 nursing need were not clear as to actions and progress. Both GP surgeries were sent surveys. Health professionals were satisfied with the care; one commented that it ‘seems to have improved recently’. Three relatives’ comment cards were returned. Two were happy with the care their relative received. Four care plans were incomplete, with some needs not being identified or actions required to meet residents’ needs not being recorded or followed up. This does not ensure that all residents’ needs are met and evidence gathered during the inspection supported this view. For example, one resident with complex needs was not being regularly supervised in relation to nutritional needs and continence management. Their relative agreed. This resident has limited communication ability but did say that they were happy and that they liked the food. A key worker is identified in the plan but this does not appear to have been translated into practice. Nutritional needs in general were not monitored. One nurse on the drug round did say ‘eat up your protein’ but the resident didn’t. No alternative was offered. Another resident walked out leaving their meal, others ate little and their plates were taken away. One ancillary staff member said that ‘even they could see that care was not provided’. Two residents were admitted out of category. The care plan did not document clear identified needs and actions taken such as counselling or referrals to appropriate health professionals. Behavioural risks were known by the acting manager but had not been assessed or addressed appropriately. It was noted from the accident book that one resident is falling out of bed frequently. This person has dementia and this home is not registered to care for people with dementia. Four of the staff on duty did not have all the necessary skills to care for a resident with dementia due to the staff members’ level of communication skills, another said that they did not care for this resident and had had no dementia training. Residents, including those who wish to participate in activities, are sometimes not assisted to get up until 11.00 and often come minus false teeth, some not arriving at all unless ancillary staff get them. There appears to be no coordination between carers’ knowledge of residents’ activities and daily programme. Staff said that there was not a key-worker system and that staff randomly assist residents to get up in the mornings. One resident was upset that they were late for lunch as they had been got up late and so the hairdressing was late. They said that this often happened as they needed two staff to help them. Other comments from residents included ‘I have to wait too long to be toileted and to get up’. Three relatives also said that residents were often in bed at 11.30 with the curtains drawn, having been put to bed at 7pm. One staff member said that bells were not answered timely. Staff, when assisting residents, were caring throughout the inspection. However, the majority of staff comment cards stated that staff did not know what to do if residents’ needs changed or what to do if they were unwell. All care plans showed excessive use of the daily notes pages, except one, which Culm Valley Care Centre DS0000037291.V289757.R01.S.doc Version 5.1 Page 13 referred to clear identified issues. Important information such as GP visits, physiotherapist action plans, short-term issues such as eye discharge or a chest infection were lost within narrative and difficult to follow up. It is commendable that there were good life histories and consents for bed rails and photos. Medication administration was inspected. The Home now uses the Monitored Dosage System and all medication had clear opening dates. Records were well used. There are photographic identifications for residents. Storage was good. The fridge is in a very warm room and the temperature has been erratic. The manager moved this medication during the inspection. The drug round was observed. In general medication was seen to be taken by the resident before the staff member administrating medication signed, other than during lunch where pots were left with residents at communal tables and signed as administered before they had been taken. Spiritual records were scant in all care plans and needs had not been referred to the appropriate people or residents’ wishes ascertained. The lay minister visits regularly but their role is not used in an effective way. Culm Valley Care Centre DS0000037291.V289757.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although those activities provided are creative and well organised they do not ensure that all residents’ social and leisure needs, particularly those with complex needs, are met on a regular basis in an appropriate format. Meals are nutritious and well presented in a congenial setting but a lack of proactive choice and nutritional monitoring does not ensure that residents receive a balanced diet. EVIDENCE: None of the six residents case-tracked seemed to be engaged in meaningful activities that suited their needs. One said that they take part in the activities, which take place three times weekly but would like to do more and have more variety. One care plan said that this person needed an activities programme, which would meet with this persons needs. This note was made in January and a plan has not been devised. One care plan said that this person is not able to participate in a social life because of physical limitations. No actions have been taken to explore other ways of meeting needs. The care plan also said that this person likes the TV and radio. The TV was on but had no sound. Culm Valley Care Centre DS0000037291.V289757.R01.S.doc Version 5.1 Page 15 One visitor said that her relative did not get enough stimulation. Other residents said that they could not take part in any offered activities therefore they did not do any. The activities helper felt that they did not have time to meet all residents’ needs in the time provided. Care staff are not involved in providing activities. The activities staff write a brief monthly summary largely unrelated to residents’ identified social needs. The activities workers get information from relatives as able, which is good. One resident had family visiting every day for most of the day. The resident had not been out of their room for a long time. A nurse said that ‘maybe they should look into this but family liked them in their room’, rather than being resident focussed. This resident cannot communicate verbally but can show non-verbally if they are happy. The relative said that they enjoyed stimulation and described activities that the resident had enjoyed at Home. Other comments by relatives and a volunteer were that the activities that were provided were done well for those who could attend and that residents enjoy them. The majority of people spoken to said that they enjoyed the food served. The Home has recently completed a menu audit and is currently working to improve meals, which is commendable. The food offered was well presented and there was a meat and vegetarian choice. There are hot trolleys, which are an improvement and food is freshly dished up. There are no menus displayed and none of the 16 residents at lunch with the inspector knew what meal was coming although they are asked the day before to choose from two meals. Five, more able, residents said that if they didn’t like it then that was it. They were unaware of alternatives and didn’t like to ask, although the manager said that alternatives are available. Some people had reported their dissatisfaction but felt they had not been listened to. The cook reports that she is aware that some people are not completely satisfied and has, on some occasions, offered alternatives. Care staff did not during the meal. The kitchen was reasonably clean and tidy. Aprons were seen available. Residents’ likes and dislikes were documented and soft diets were well presented. One volunteer said that residents often say that breakfast is not served until 10.00 and that there is little choice. Three residents and a staff member agreed with this statement. A number of residents require help with their meals and the assistance offered was variable. One carer put food in front of sleeping residents and then left the room. Food was taken away from a resident but none of the meat had been eaten. It is unclear how this was reported or if it was recorded. One visitor said that she tries to visit at lunchtimes so that she can be sure her relative has enough to eat. She believes that carers give up too quickly because of the resident’s special needs. Some carers were seen feeding residents whilst standing over them. One carer gently prompted a resident awake and reminded them to eat their lunch, which they did. Staff in the dining room did not communicate with residents as they gave out the meals. One had to dish it up and the other put them in front of the residents without speaking. One staff member chatted with a resident as they received assistance and there was a Culm Valley Care Centre DS0000037291.V289757.R01.S.doc Version 5.1 Page 16 good rapport. However, the resident ate little and it was taken away. The staff member was very caring and obviously knew the resident well but said that they did not record their intake anywhere. Culm Valley Care Centre DS0000037291.V289757.R01.S.doc Version 5.1 Page 17 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The systems in place to help protect and consistently act upon resident’s complaints are poor. Residents are adequately protected from abuse by sound procedures and practices. EVIDENCE: One GP said that they had received complaints from relatives about care given to residents under the Community Admission Scheme and that these had been dealt with appropriately at the time. These complaints were not documented at the Home. Two relatives and two residents spoke of detailed issues, which they had raised with the acting manager. They felt listened to but nothing was done. These were not in the complaints book. This only contained complaints received by CSCI and one other. These had been well investigated and the responses were good. Staff spoken to said that they did not write any complaints anywhere. There has been Protection of Vulnerable Adults training since the last inspection. Staff spoken to were aware of procedures, which is a great improvement. The response from comment cards was mixed with half ticking that they were not aware of the complaint’s procedure. Most staff were unaware of policies relating to accusations. Care plans showed good recording and discussions with residents about any restraint measures and consent. Culm Valley Care Centre DS0000037291.V289757.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of the décor and cleanliness within the home is satisfactory, especially the garden and front patio, but aspects of the environment do not meet individual residents’ needs. EVIDENCE: The inspectors toured all areas of the Home other than store areas on the second floor. The hairdresser’s salon was in full use and all areas of the Home appeared to be clean during the inspection. The majority of comment cards felt that the Home was either always or usually fresh and clean. There was a slight offensive smell in some areas but this may be due to the fact that residents were being assisted with getting up until 12.00. There are electric air fresheners on every floor. The laundry was tidy with 2 commercial washers and driers. Clothes were piled tidily in separate named residents’ slots. The manager said that the Home is about to start a re-decorating programme. Some carpets need replacing especially the corridors and walls need touching Culm Valley Care Centre DS0000037291.V289757.R01.S.doc Version 5.1 Page 19 up especially banged corners. This will be included in the programme. The dining rooms were beautifully laid out and there is lots of communal space. The front patio was bursting with flower-pots and shady seating areas and the garden looked very well maintained. The back patio area, which is accessible through some residents patio doors needs attention as it would not be a pleasant place to sit at present. One resident had the door blocked by furniture but was not available to ask if this was their choice or whether they would access the patio if it were presentable. There is a lip at the door to get over in order to reach this area. It was not clear as to whether the patio would be accessible for the residents in these rooms, although the doors open, or whether this had been risk assessed. Culm Valley Care Centre DS0000037291.V289757.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The skill mix of competent staff is not always sufficient to meet individual residents’ needs. Recruitment systems are not robust, especially for volunteers, therefore not ensuring that residents are protected. EVIDENCE: The inspector observed carers giving care. Some carers were gentle and sensitive and engaged the resident as far as possible. A volunteer commented that one nurse was ‘caring and considerate about residents’ welfare’. Others were less engaging and appeared to be in a hurry, for example standing over a resident whilst feeding them and sitting on the arm of a chair in front of resident whilst giving them a drink. One resident reported that some of the staff ‘shout’ at one resident. Other residents, staff and a visitor had not heard this. A previous complaint had raised this but there had been insufficient evidence. The inspector overheard a carer who sounded ‘short’ with a resident who was calling out. This may be a cultural issue, but does need addressing. One visitor said that staff are busy and can promise to do something for a resident and then this is not done. She said ‘these little things are so important when you sit in one chair and in one room for twelve hours every day’. All the staff spoken to said that things had improved since the morning staffing numbers had increased by one. This carer floats between the floors. There are Culm Valley Care Centre DS0000037291.V289757.R01.S.doc Version 5.1 Page 21 usually 2 RGNs on duty, one on each floor with 3 carers on each. Care staff said they remain busy and needed more able staff. All staff spoken to said that there were not enough staff who were well trained to do the job, one felt that residents’ mental health needs had increased at the Home but that they weren’t involved in this care and did not know how to. A nurse said that they felt that out of the 6 carers on duty 5 needed supervision or support during the shift. One carer, with excellent knowledge of residents’ needs, said that they knew that another carer’s communication with residents was minimal but that they did not have time to mentor them. Communication with residents was seen to be generally task related and no staff were seen spending time chatting to residents, other than one carer during their break. Three staff said they did not have time to talk to residents. Only one staff comment card out of 9 said that they had the time to provide the care required by residents. One resident was upset that they were late for lunch as they had been got up late and so the hairdressing was late. They said that this often happened as they needed two staff to help them. Other comments from residents included ‘I have to wait too long to be toileted and to get up’. Three relatives also said that residents were often in bed at 11.30 with the curtains drawn, having been put to bed at 7pm. One staff member said that bells were not answered timely. During the inspection call bells were turned off by staff, who then spent time looking for another to help them. One relative did comment that the care that a resident received was perfect and another said that although care was not done in a timely way, it was good and their relative was well looked after. Many residents were sat for an hour waiting at the table for lunch. In general care was seen to be given in a gentle and caring way but not in a timely manner. The manager did not know the overall dependency levels of residents at the Home. Staff said that most residents needed two staff to assist them. The recruitment records for four recently appointed staff were inspected. All had the necessary checks including references and a Criminal Records Bureau (CRB) check. Records are well managed and easy to audit. One volunteer has not undergone a CRB as required. The administrator said she would arrange this immediately. This volunteer also commented that they had received no information about their expected role, an ID badge or any information about policies such as POVA or gifts and that they would also be happy to provide staff with support as wished. Two other volunteers had also not received any training, job description, ID, CRB, information on policies or any information about residents’ individual needs. One felt that they did not have time to meet these needs in the time provided and both felt that there should be more care staff. Care staff are not involved in providing activities or liasing with activity staff, which could put residents who are involved with activities at risk of not having all their needs understood. Some staff comment cards said that they had not had an ID badge or relevant training. Most were clear on the disciplinary procedure. Training records were scant and had been recently filled out. It was impossible to know which staff had done mandatory training and who needed to update. The manager was currently looking into this. The manager has had a lot of input in providing Culm Valley Care Centre DS0000037291.V289757.R01.S.doc Version 5.1 Page 22 training such as Dementia Care and infection control. Three staff have NVQ training, which is a total of 2 of the care staff group. Others have minimal experience in care. There should be 50 of care staff with at least Level 2 NVQ qualifications. Culm Valley Care Centre DS0000037291.V289757.R01.S.doc Version 5.1 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all staff receive clear leadership and guidance to ensure that residents receive quality care in a safe environment. Residents’ financial interests are well safe guarded. EVIDENCE: The Home has been without a Registered Manager for some time although the Home are actively recruiting. There is an acting manager, who is a Registered Mental Health nurse. The registered nurses felt well supported and the Home has undergone a period of change as part of the improvement plan to restructure the organisation in the Home. It is acknowledged that this will take time for staff to adjust to new roles. Culm Valley Care Centre DS0000037291.V289757.R01.S.doc Version 5.1 Page 24 The majority of care staff comment cards stated that they did not feel supported or respected by management. The carers generally felt undervalued and demoralised and that they had no time to do their jobs in care as well as ancillary tasks. Staff reported that they do not always get their breaks in the morning and say these issues have all been reported to the manager but nothing has been done. Some said that they had not received any staff supervision sessions. The acting manager said that nurses had regular meetings, which were successful but carers and ancillary staff did not. Most of the care staff spoken to would like to attend regular meetings and said that no-one checked their work or praised them. One carer said that it would be easier to ask a relative to convey staff concerns as things only got done after relatives’ meetings such as particular residents getting up earlier. One relative said that staff morale was low. Another said that they had been told ‘if you don’t like the job go and work in a supermarket’. The Home is currently receiving and collating quality assurance questionnaires. These need to indicate whether advocates had been sought and who assisted residents to fill them out. The Registered Provider conducts monthly Reg 26 visits. There was a good response to issues relating to food provision and a detailed audit. There are regular relatives’ meetings, which is commendable. The system for dealing with residents’ monies was inspected. There are clear individual balance sheets and receipts and all three inspected were correct. The administrator is very efficient. Residents can sign for lockable storage. It would be good practice for all those residents who do look after their own money to be pro-actively offered this, one had not. The Home does not act as appointee for any resident. Invoices are sent to relatives every month and the Home ensures that all residents are able to have everything they need. Fire and other equipment are regularly checked. The Environmental officer visited in April and the manager said that requirements were being dealt with. There is a current electrical wiring certificate. COSHH substances are well stored and risk assessed. One carer found it very difficult to understand the inspector when asked simple questions about a hoist’s maximum load. There are insufficient training records meaning that it is difficult to see what Manual Handling training is provided. Culm Valley Care Centre DS0000037291.V289757.R01.S.doc Version 5.1 Page 25 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 2 1 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 x 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 1 28 x 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 x 3 x x 2 Culm Valley Care Centre DS0000037291.V289757.R01.S.doc Version 5.1 Page 26 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 OP3 Regulation 14 Requirement Timescale for action 01/07/06 2. OP7 15 (1) 3. OP8 12(1) You must ensure that the needs of the resident have been assessed in consultation with the resident prior to admission and that this is kept under review. This also refers to adequate records and relation to the care plan. You must, after consultation with 01/08/06 the resident or representative, prepare a written plan as to how the resident’s health and welfare are to be met and keep under review. See textbox Health and Personal Care. This is carried over from the previous inspection. Timescale 13/12/05 unmet. You must ensure that the Home 01/07/06 is conducted so as to promote and make proper provision for the health and welfare of residents and make proper provision for the care, treatment, education and supervision of residents. See textbox for outcome group Health and Personal Care. This is carried over from the DS0000037291.V289757.R01.S.doc Version 5.1 Culm Valley Care Centre Page 27 4. 5. OP9 OP11 13 (2) 12 (3) 6. OP12 16(2) 7. OP16 17 (2) 8. OP30 18 1a previous inspection. Timescale 13/12/05 unmet. You must make arrangements for the safe administration of medicines in the Home. You must, for the purpose of providing care to residents, and making proper provision for their health and welfare, so far as practicable ascertain their wishes and feelings. This refers to spiritual care and was previously an unmet recommendation. You shall having regard to the size of the Home and number and needs of the residents consult them about the programme of activities (relating to their needs and capabilities) and provide facilities for recreation and fitness and training as appropriate and record these in relation to the care plan. This is carried over from the previous inspection and must include all residents. Timescale 13/12/05 unmet. You must maintain records specified in Schedule 4. This refers to the complaints book, ensuring that all complaints/concerns are recorded and followed up using the Home’s complaint’s procedure and that residents and relatives are aware or reminded of this procedure. You shall ensure that at all times there are suitably qualified, competent and experienced persons working at the Home in such numbers as are appropriate for the health and welfare of residents and that they are appropriately supervised. This is carried over from the previous inspection. Timescale 13/12/05 unmet. DS0000037291.V289757.R01.S.doc 01/07/06 01/09/06 01/08/06 01/07/06 01/08/06 Culm Valley Care Centre Version 5.1 Page 28 9. OP29 19 You must obtain for all persons 16/07/06 working at the Home appropriate documentation prior to employment as in Schedule 2. all staff should have CRB checks in place or as a minimum a POVA first and to work supervised. This refers to volunteers. This is carried over from the previous inspection. Timescale 13/12/05 unmet. 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. Refer to Standard OP2 OP11 OP15 Good Practice Recommendations It is recommended that all residents/representatives are aware of the contents of the Home’s terms and conditions and that this is recorded. It is recommended that residents wishes regarding spiritual needs are discussed, recorded and acted upon as appropriate. It is recommended that there is better communication during mealtimes between staff and residents and that staff are pro-active in offering choice and monitor satisfaction. It is recommended that the back patio areas are risk assessed and made accessible to those residents and made a more pleasant area. It is recommended that staff training records are kept up to date and taken into account when devising the staff rota to assess skillmix. It is recommended that residents are facilitated to fill out quality assurance questionnaires anonymously or with advocates rather than care staff as able and that this is recorded. It is recommended that all records and training related to Manual Handling are up to date. 4. 5. 5. OP19 OP30 OP33 6. OP38 Culm Valley Care Centre DS0000037291.V289757.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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