Inspection on 13/09/05 for Culm Valley Care Centre

This inspection was carried out on 13th September 2005.

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 01/06/06

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 Unannounced 13 September 2005 th 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 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 D54-D06 37291 Culm Valley 244811 130905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Culm Valley Care Centre Address 10 Gravel Walk, Cullompton, Devon Telephone number Fax number Email 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 Ashdown Care Limited, Halcyon House, 24 Coombe Lane West, Kingston Upon Thames, Surrey KT2 Mrs Patricia Carol Quick Care Home with Nursing 56 Category(ies) of PD(E) Physical Disability - over 65 (56) registration, with number OP - Old Age (56) of places Culm Valley Care Centre D54-D06 37291 Culm Valley 244811 130905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 010/4/2002 Notice of Proposal to Grant Registration staffing/environmental conditions of registration issued 27/11/2001 16/12/2002 Registered for up to 6 people Intermediate Care (50 years and above) 12/12/2003 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. 15/01/2004 This variation allows for the admission of one named person under the age of 65 in the category PD Physical disability, and one named person over the age of 65 in the category DE[E] Dementia 15/01/2004 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. Date of last inspection 26/04/2005 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 and patios. Culm Valley Care Centre D54-D06 37291 Culm Valley 244811 130905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place with 2 inspectors on Tuesday 13th September 2005 from 08.45. One inspector met with 10 residents and a relative of one, as well as a community-based health professional, two care assistants and a laundry staff member. Of the residents, one declined to speak to me and the majority were unable to give their views in much detail because of their frailty. Another inspector spoke to 4 staff members, 7 residents (2 were unable to understand the inspection process due to confusion). On arrival there were three men and a female resident having breakfast in the first floor lounge. Others were being delivered breakfast on trays in their rooms before they were assisted to get up. Most residents were in bed. The Home did not feel overly busy during this time and staff said that they normally go around and sit residents up to have breakfast. At 09.15 the manager found the inspectors and welcomed them. They had brought some specialist equipment to aid a resident with a disability. Later throughout the inspection staff were not very visible around the Home apart from lunch- time and call bells were constantly ringing. The Home appeared to be very busy. Due to the negative content of this report CSCI met with the Registered Provider and the Director of Care on 22/09/05. The issues identified during the inspection were discussed in depth. They agreed that the findings were unacceptable and reassured the inspectors that they will make every effort to address them as a priority and will keep CSCI informed of progress. The inspectors will be carrying out a further unannounced additional visit within the next 4 months to assess progress. Two anonymous complaints relating to issues identified within this report were also given to the Provider to investigate. What the service does well: The staff training opportunities and general standard of cleanliness around the Home were good at the time of the inspection. Although there are issues with the delivery of care all residents said that the staff were very kind and treated them with respect. There were only positive comments relating to staff attitude. Meals are varied, well balanced and nicely presented in a pleasant setting and offer choice. All residents spoken to enjoyed the meal times with the majority eating in the lounges as a social occasion including relatives and friends whilst others were able to choose to eat in their rooms. Culm Valley Care Centre D54-D06 37291 Culm Valley 244811 130905 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Culm Valley Care Centre D54-D06 37291 Culm Valley 244811 130905 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Culm Valley Care Centre D54-D06 37291 Culm Valley 244811 130905 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4, 6 Although initial resident assessments are thorough the Home does not ensure that the Home can meet residents’ needs. EVIDENCE: There were full pre-admission assessments of needs of each resident, by the Manager (and Social Services, where relevant); the nurse was aware that one admission the previous day had no paperwork completed as yet. The Home has a dependency level tool which the manager looks at monthly. This is comprehensive and shows that the majority of residents are high to very high dependency requiring 2 staff to assist with activities of daily living. Staff said that 13 residents need feeding on one floor and a high number on the other floor. Care attendants are on duty usually from 10am, therefore not for breakfast and then after 7pm so not for supper. 9 residents need the hoist and 2 staff to mobilise on one floor. Throughout the inspection carers were turning off the call bell in a room and going to look for another carer. One resident had rung the call-bell and was shouting for 20 minutes, wanting to go to bed. They said that they had been in the chair since 6am, this was 2pm. The carer turned off the bell and 40 minutes later the resident was still in their chair. One resident said that Culm Valley Care Centre D54-D06 37291 Culm Valley 244811 130905 Stage 4.doc Version 1.40 Page 9 waiting 15 minutes was good as they and their relative had made various complaints as they have to wait 1 and a half hours for help to go to the toilet. Two complaints have been received by CSCI in relation to this issue and the provider will be investigating. One resident said that they often do not see a carer from lunchtime to suppertime. Another resident who did not ring the bell was left alone during this time; one carer popped their head around the door once but did not acknowledge the resident. This was also commented by a relative as something that often happened. The Home does not have as many GP scheme beds now. Staff said that this reduced the resident turnover. One staff member is delegated to liaise with GPs weekly and there was comprehensive information about those residents in intermediate care beds but a health professional and residents and staff said that there was no time to deliver mobility care planning effectively. Culm Valley Care Centre D54-D06 37291 Culm Valley 244811 130905 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 Care plans do not clearly reflect residents’ needs, which are not being met. EVIDENCE: One inspector looked at 3 care plans. One had very good detail, and reflective evaluations (including of activities) that had been recorded regularly. Care records included use of risk assessment tools for relevant potential health problems, etc., which were used as part care plans for acute care needs. However, these were not cross-referenced to care plans for long-term needs, as would have been useful (especially since the same need was sometimes included in both sections, giving different information but information that was equally relevant to informing care staff). One resident had a large, old bruise on their leg, but this was not recently reflected on a skin assessment chart or in care records. For example, a care plan for ‘Eating/drinking’ did not refer to the level of risk identified by the nutritional assessment tool. The care plan template is very comprehensive, but in practice it was not always completed so was less helpful than it might be. There was little evidence that social or spiritual needs were being properly identified and planned for. For example, on admission, the ‘Spiritual needs’ care plan for a confused resident said ‘none expressed at the moment’. Information obtained after admission states the resident used to belong to a church, but there is no evidence that the Culm Valley Care Centre D54-D06 37291 Culm Valley 244811 130905 Stage 4.doc Version 1.40 Page 11 care plan was reviewed with the resident in the light of this information. Similarly, although prior to admission it was identified that this resident would need a ‘sociable life’, information later obtained in a short personal history has not been used in the care plan, and evaluations of activities provided suggest they are inappropriate for the resident’s level of mental health, but there is no evidence that this is being addressed. A frail resident that had been at the Home for a month did not have a completed care plan for staff to refer to. Daily evaluations had not been recorded during the first few weeks of their admission. No residents or relatives asked recalled being invited to discuss their care or a care plan with staff. Care plans had been recently updated, but it was noted that in the recent past, reviews had been less frequent. Although a care plan for a resident admitted in 2004 had been audited, identifying what needed to be done further to bring the records to the expected standard, no further action had been taken. The audit itself was undated. There was a good activities care plan but this is completed by the activity staff not care staff, who have no input. Only ‘regulars’ were being brought down to the lounge to watch the cricket. A resident who was documented as liking sport was not asked. Documentation concerning a resident who has severe and complex communication difficulties was vague and staff were seen to talk at them. One staff member said that they just ‘know’ what they are saying but no pro-active means of communication or multidisciplinary team working had been applied. This resident was also documented as being very frustrated if they are not understood and had been very agitated and aggressive. No action or reasons why had been addressed. Four residents and a relative said that they had never seen their care plan. There was clear guidance for staff regarding fluid intake. Health risk assessments were used, and regularly updated, forming the basis for care planning. GP and district nurse involvement was recorded. The Home routinely screens all residents for diabetes (with their consent). Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Two nurses said they had no problems with the supply of medication - stocks being available when needed, etc., and the supplying pharmacist readily giving advice. Medication charts were appropriately signed, had the residents’ photos attached, and stocks of controlled drugs were recorded appropriately. Oromorph bottles and insulin vials were not being dated when first used. Drug fridge temperatures are recorded regularly but not minimum/maximums. Staff were heard being cheerful but polite when attending to residents. Recent letters of thanks were seen; thanking the Home for the way residents had been cared for by staff. There were serious concerns around privacy issues, however, linked to call bells not being answered promptly. When staff were with residents they were seen to be treating them with respect and care. The information collated relating to spiritual needs is vague stating ‘the resident has not indicated that they have any spiritual needs’ and ‘they have not expressed any fears for the future’. Culm Valley Care Centre D54-D06 37291 Culm Valley 244811 130905 Stage 4.doc Version 1.40 Page 12 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 standard(s) 12, 14, 15 Social activities and choice are not well managed for all residents. Meals are nutritious and balanced offering a healthy and varied diet. EVIDENCE: A resident said they enjoyed the church services held at the Home. A Harvest supper followed by ‘Songs of Praise’ was planned for later in the month. Residents received information on forthcoming events in a monthly newsletter, as well as notice boards showing details of planned activities, etc. A relatively new, frail resident with poor sight, who spent most of their time in bed, said they loved music and would like someone to come to chat to them occasionally. There was no provision for music seen in their room (other than a television), and no evidence in care records that their social or recreational needs were being addressed. A visiting relative had no complaints about the way the resident they visited was cared for, and felt able to come and go as they pleased (taking the resident out for a short walk in the grounds during the inspection). Staff were overheard offering residents more to eat at mealtimes, and checking if they wanted anything when passing residents sitting in their own rooms if they could communicate. One resident said that it was usual now for them to be in bed at 12.30 as there were no staff to assist them with the hoist. They would prefer to get up earlier. Culm Valley Care Centre D54-D06 37291 Culm Valley 244811 130905 Stage 4.doc Version 1.40 Page 13 Those spoken with said the food was ‘excellent’ or ‘very good’ (- one adding that they thought this despite being a ‘fussy eater’), with sufficient portions, and variety offered. Cooked breakfasts were available. One carer was seen to be feeding a resident sensitively. Culm Valley Care Centre D54-D06 37291 Culm Valley 244811 130905 Stage 4.doc Version 1.40 Page 14 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 standard(s) 18 The Home does not ensure that residents are protected from harm or abuse. EVIDENCE: Three staff were aware of some aspects of protection of vulnerable adults although they had not had any training at the Home. However, they were not clear about other significant aspects, such as a response if one resident hit another or the procedure when reporting. Inventories of residents’ personal property are kept. Consent for bed rails and lap straps was not always obtained or discussed with the multidisciplinary team or relatives although many were used. The majority were signed by two staff members with no formal risk assessment or structured maintenance plan. Culm Valley Care Centre D54-D06 37291 Culm Valley 244811 130905 Stage 4.doc Version 1.40 Page 15 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 standard(s) 19, 22, 24, 26 The environment is generally clean but some issues in the Home could put people at risk of serious harm and impact on their safety. EVIDENCE: There is a lovely entrance with water feature and flowers. The manager said that there was a certain amount of time allocated each day to the handyman for decorating. By December the first floor will be re-decorated. The current domestic also does extra maintenance hours. Resident’s rooms were generally well personalised and clean. Where corridors and doorways were showing signs of wear and tear, the Manager said there was a rolling programme for redecoration – a floor of the Home taking approximately three months to repaint, etc. Three ceilings around the Home were showing signs of water stains. A bathroom and sluice room were out of use. Some hoists were rusting. Communal areas were free of malodours, and looked clean despite the relatively early start of the inspection. One room had an unpleasant odour, despite washable flooring, and a soiled chair but this was an ongoing problem, which the Home was aware of. Culm Valley Care Centre D54-D06 37291 Culm Valley 244811 130905 Stage 4.doc Version 1.40 Page 16 One chair needed a good clean as it was smeared with old food. Another chair was smeared with old faeces. There are designated soiled laundry bins with plastic inners and an electric air freshener system. Bins clearly stated if they were not for dressings or aprons. There were plenty of alcohol gels and clear clinical guidelines. Laundry staff described appropriate methods for dealing with soiled laundry, including use of alginate bags. Washing machines had recommended programmes. The area was well organised. Handling slings were shared between residents, which could create a crossinfection risk. One resident said their call bell had not worked for some time, and it was not working when checked by the inspector. Another resident was calling out to staff because they wanted help; they thought they had already rung the call-bell, but the inspector found it was not working. Culm Valley Care Centre D54-D06 37291 Culm Valley 244811 130905 Stage 4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 The procedures for recruiting staff do not provide safeguards for the protection of residents. The numbers/skill mix/organisation of staff is not sufficient to meet residents’ needs. EVIDENCE: At the time of the inspection there were 3 RGNs across the two floors and 7 carers. Staff said that this was not normal and that recently there had been only 6 carers and 2 RGNs. Two weeks rota was looked at but these were predictive not actual hours worked. Minimal agency are used if possible. All staff spoken to felt that they were doing too much and said that all staff were stressed. One staff member felt that something should be done. One staff member was reluctant to elaborate on the causes of the stress. Two carers were heard to say that it wasn’t good that RGNs were included in the numbers on the floor as they were not available to do care duties. RGNs are supposed to meet with the manager at 11am every day for an update but they are too busy to do this. Some staff are long term staff that said that they feel frustrated that they cannot give proper care and do it all. There was a general feeling that staff morale was low. All residents spoken to said that staff were generally nice but that they did not have time for them. It is noted that 2 qualified nurses were starting employment the following day. The atmosphere was peaceful and calm at the start of the inspection. As the day went on, staff were busy, continually occupied with caring for residents, most of whom required help from two staff because of handling needs. Care attendants Culm Valley Care Centre D54-D06 37291 Culm Valley 244811 130905 Stage 4.doc Version 1.40 Page 18 were still assisting residents in their bedrooms with breakfasts at 11am. One carer was feeding a resident who was lying down in bed. Staff were seen to be feeding some residents at 2.30pm. The breakfast trays with hot porridge on were left in the corridor for some time until a carer could feed the resident. One resident said there were always new faces. But there is a core of longserving staff. Regarding staffing levels, one said it was hard to get hold of staff. Another said ‘you can always do with more staff’. Staff were generally described as ‘good’ and were patient with the residents. Another resident said they had no complaints about the staff attitudes. A community-based professional (when asked about communications with the Home’s staff during their visits) said staff were busy and preoccupied, appearing to have so many things to deal with. On following up their professional advice, they said staff did not seem to have time for remobilisation of residents. A visitor felt it was due to their actions rather than those of the staff that the resident they visited had regained their mobility following hospitalisation. Care assistants felt nurses shouldn’t be included in minimum staffing levels from the point of view that they didn’t help get residents up and this was what took up most care hours. With staff having to work in pairs to assist residents appropriately, it was difficult for care assistants if there were three not four of them on duty. Two staff independently said there had been only six staff on the previous week, not eight as on the day of the inspection – a comparatively well staffed day, according to staff. This could not be verified by records. They did not know why staffing levels varied in this way. A staff said there were communication issues relating to staff whose first language was not English. They were not aware of any strategies or guidance planned or in place to deal with this problem, but they intended to discuss the matter with senior staff. There are still a number of staff who have no CRB check and are working without supervision. This must stop. All staff must at least have been checked by POVA First but no staff member must work without supervision if they have no CRB check. Staff training files showed a range of mandatory and additional training had been given. Two care assistants spoken with had obtained NVQs in Care, one had NVQ3, the other had NVQ2. Three had attended some training specific to residents’ needs, and they spoke about information leaflets that were given to all staff weekly by the manager, each on a different topic. The Home intends to look at monitoring competencies and practice in the near future. Culm Valley Care Centre D54-D06 37291 Culm Valley 244811 130905 Stage 4.doc Version 1.40 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 36, 38 The Home is not clearly managed to ensure that staff are clearly supported and directed to ensure consistent care in a safe environment. EVIDENCE: A valid Employers’ Liability insurance certificate was displayed at the Home’s entrance. Leaflets on various topics were available at the entrance to the Home, with other information available on notice boards around the Home. There was clear guidance for staff on standards for personal care given to residents available. The manager said that they felt frustrated that they could not be more visible around the Home and that staff had commented that they were not available. One staff member said that the manager doesn’t know what is happening on the floor, doesn’t listen to staff and doesn’t come to see how staff are struggling but comes once a month to shout at staff. They did stress that the manager was a nice person and that they were very flexible allowing staff to Culm Valley Care Centre D54-D06 37291 Culm Valley 244811 130905 Stage 4.doc Version 1.40 Page 20 work individual shift patterns. Staff said that staff were not allowed to have group staff meetings as they turn into ‘grumbles about pay and conditions’. There have been no staff meetings for some time, possibly 2003. Staff did not feel listened to. A notice offers staff time to see a senior carer. An RGN said that they would not do this. They found it difficult to do paperwork and admitted that some admission paperwork and care plans were often not done. One staff member said that they often stay late unpaid. When there are two RGNs on duty in the mornings they felt that this was harder. One staff member also commented that other staff had become stressed and tearful. Two residents were not aware of any quality surveys. One said they saw less of the manager than they used to. One said they rarely saw senior staff. However, care staff said if there was a third nurse on duty on a floor, it was their role to visit each resident that day, and see if they had any concerns. One staff member did not know what a quality assurance system was. Senior staff, including the Manager, were said to be very approachable. Staff said they had supervision and appraisals were being done currently, and a new system for organising each shift had recently been commenced, which were said to have improved matters. Handovers/reports were said to be useful, and were used, with care plans, by staff to inform themselves of residents’ care needs. Two care assistants said they had had recent training in fire safety and manual handling. They said awareness of health and safety was being raised by a new Health & Safety representative’s team at the Home. One staff said they were not aware of any current environmental hazards or factors adversely affecting their ability to do their job. The person responsible for fire training had had appropriate training themselves for this responsibility. Regular fire drills were carried out, using scenarios and practical testing to assess staff knowledge. These were recorded separately to other fire safety tests. However, some staff had not had fire safety training for over a year. There was evidence that fire alarms were regularly tested but this had not been recorded weekly in the fire log in recent weeks. Other tests and checks were recorded appropriately. An incident was well recorded in the accident book. Culm Valley Care Centre D54-D06 37291 Culm Valley 244811 130905 Stage 4.doc Version 1.40 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 1 x 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 1 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 1 15 3 COMPLAINTS AND PROTECTION 2 x x x x 3 x 1 STAFFING Standard No Score 27 1 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 1 x 1 1 x x 3 x 1 Culm Valley Care Centre D54-D06 37291 Culm Valley 244811 130905 Stage 4.doc Version 1.40 Page 22 yes Are there any outstanding requirements from the last inspection? 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 4 and 8 Regulation 12 (1) Requirement You must ensure that the Home 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 textboxes You shall, after consultation with the resident/representative prepare a written plan as to how the residents needs in respect of his health and welfare are to be met, make avilable to resident, keep under review and notify resident of any revision. You shall make suitable arrangements to ensure that the Home is conducted in a manner which respects the privacy and dignity of residents. 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 and appropriate. You shall so far as practicable Timescale for action 13/12/05 2. 7 15 13/12/05 3. 10 12 (4) 13/10/05 4. 12 16 (2) 13/12/05 5. 14 12 (2) (3) 13/12/05 Page 23 Culm Valley Care Centre D54-D06 37291 Culm Valley 244811 130905 Stage 4.doc Version 1.40 6. 18 13 (6) 7. 22 23 (2) 8. 26 13 (3) 9. 27 18 10. 29 19 11. 38 13 enable residents to make decisions with respect to the care they are to receive and their health and welfare and so far as practicable take into account their wishes and feelings. You shall make arrangements by training staff or other measures to prevent residents from being harmed or suffering abuse or being placed at risk of harm or abuse. You shall ensure that equipment provided at the Home is maintained in good working order. callbells and hoists. You shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the Home. 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.see below. You must obtain for all persons working at the Home appropriate documentation prior to employment as in Schedule 2. You must ensure that unnecessary risks to the health and safety of residents are identified and so far as possible eliminated. Fire training. 13/11/05 13/11/05 13/11/05 13/12/05 13/12/05 13/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Culm Valley Care Centre D54-D06 37291 Culm Valley 244811 130905 Stage 4.doc Version 1.40 Page 24 No. 1. Refer to Standard 9 Good Practice Recommendations It is recommended that all medications with a limited shelf life are dated on openeing. ie Oromorph and insulin and that minimum/maximum fridge temparatures are recorded. It is recommended that the residents wishes concerning terminal care and arrangemtns after death are discussed and carried out. It is recommended that the Home is properly maintained ie ceilings, bathroom and sluice and rusting hoists attended to. 2. 3. 11 19 Culm Valley Care Centre D54-D06 37291 Culm Valley 244811 130905 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection Exeter Office, Suites 1 & 7 Renslade House Bonhay Road Exeter, EX4 3AY Tel: 01392 474350 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. Extracts may not be used or reproduced without the express permission of CSCI Culm Valley Care Centre D54-D06 37291 Culm Valley 244811 130905 Stage 4.doc Version 1.40 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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