Inspection on 15/04/08 for Culm Valley Care Centre

This inspection was carried out on 15th April 2008.

CSCI found this care home to be providing an Poor 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

Culm Valley Care Centre 09/10/08

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 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 15th April 2008 07:30 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.V362447.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 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 ****Post Vacant**** 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.V362447.R01.S.doc Version 5.2 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 On the termination of the placement of any of the named service users the Registered Person will notify the Commission and the particulars and conditions of this registration will be altered. To admit one named persons outside the categories of registration in the category DE [E] as detailed in the notice dated 31st July 2006 9th August 2007 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 Re-Ablement 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 en-suite, and 6 double rooms. There is plenty of car parking and a spacious and level landscaped garden with patios accessed from the first floor corridor and some residents’ rooms. The cost of care ranges from £299 -603 per week at the time of inspection, depending on the needs of each individual. 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.V362447.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This unannounced inspection took place on Tuesday 15th April 2008 07.3019.00 with 3 inspectors and on Wednesday 16th April 2008 14.00-19.00 with 2 inspectors. On Friday 18th April 2008 the Pharmacy Inspector also carried out an inspection of the Medication systems. This information was used to compile the report. Information was also received in the form of concerns from 6 other sources: relatives, a health professional, and a member of the public and exstaff members. Surveys were also sent by CSCI to care managers, people living at the Home and staff. Seven were returned from relatives, two from people living at the home, one from a care manager and two from staff members. Although the person living at the Home was positive generally the surveys raised concerns in a variety of areas. The Home sent back the AQAA (Annual Quality Assurance Assessment), which provides additional information in the form of self-assessment. During the inspection one inspector looked at each of the floors and another observed care in the communal areas. Nine people living at the Home were case-tracked. This means that we look at their care as a whole to see what their experience of life living at the Home is like. A wide range of relevant records were looked at, including care records, policies and procedures, medication, staff recruitment and training as well as talking to the Manager, Operations Manager, staff (Carers and Registered Nurses, Activities Organiser, Kitchen staff) and relatives. We were concerned about repeated breaches in regulations and therefore a number of records relating to plans of care, staff handover notes, rotas and medication were seized during this inspection. We also issued some immediate requirements relating to care for two individuals. A response was due by 25/04/08 and was received in time. The Home have dealt with these issues appropriately since the inspection. Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 6 The Provider, Operations Manager and the new acting manager are keen to work with the Commission to work towards improvement. A Random inspection was also carried out in February 2008 due to some concerns raised within a complaint to CSCI. These were upheld and we met with the Provider, Operations Manager and proposed acting manager to discuss their action plan and their proposed way forward. What the service does well: What has improved since the last inspection? What they could do better: 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. Some concerns have been relayed to staff by relatives on various occasions but nothing has happened as a result. Activities must be offered which meet all residents social and leisure needs, including those people who are unable to access the communal areas or have limited communication. Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 7 The Home must ensure that staff on duty have the necessary skill mix to deliver care meeting residents’ needs. Although there are qualified nurses on each shift, only one care assistant has a qualification in care and many of the staff are new, some having little training or induction. People do not always benefit from competent or adequately trained staff. Manual handling training records should be kept clearly up to date to ensure that people are safe. Staff should be monitored to make sure that they are clear about safe practices and the training should be reviewed to be certain that it is delivered correctly and is up to date. Pre-admission assessments must be detailed enough to ensure that the Home can meet peoples’ needs. At present records are poor which means that new admissions cannot be sure that their needs have been identified. Health care needs must be met consistently to ensure that people are not put at risk. Various areas of health care delivery are poor with basic needs not being addressed or identified by staff such as personal hygiene, nutrition and medical assistance. This is not acceptable. Communication between people living at the Home Is poor and there needs to be improvement relating to language skills and meaningful engagement for all people living at the home. Communication is poor in general, with the focus being on performing care tasks. Other barriers to good communication by staff include lack of knowledge and limited English language skills. Sharing of information between staff must improve to ensure that they have enough knowledge to meet peoples’ needs, for example during handover and reading care plans. Nutritional needs are not well met for all people at the Home putting them at risk. Those people who need assistance with eating and drinking and have a medical condition that puts them at risk are not always monitored to ensure that they have adequate fluid and calories. Standards of infection control do not protect people meaning that there are some areas of poor practice. People are not fully protected from harm by sound knowledge and policies about Protection of Vulnerable Adults and reporting. Not all staff receive clear leadership and guidance to ensure that residents receive quality care in a safe environment. Staff are ‘popping in to see people living at the Home to check they are ok’ but some staff have no knowledge of these peoples’ needs or what they should be doing. Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Culm Valley Care Centre DS0000037291.V362447.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 Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The assessment information for some people living at the Home is poor and inconsistent potentially putting people who move into the Home at risk and could result in needs not being met. EVIDENCE: We looked at the pre admission assessments of four of the most recently admitted people. These admissions occurred prior to the current acting manager being in post. Records show that two of these people did not undergo assessments to determine their needs before they moved into the home. The third assessment had no name on it. The information recorded lacked any detail and did not determine the needs of the person it related to. This person had been assessed by Social Services as requiring the highest level of Nursing care. Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 11 Another assessment was not signed or dated and there was little detail to inform staff properly of this person’s needs to ensure consistent care. For example, ‘Eating: eats and drinks independently.’ ‘Mobilising: off of legs needs hoisting.’ ‘Social activities: social person usually.’ ‘Religious needs: C of E.’ ‘Personal hygiene: needs help from staff at present.’ There were notes from a Housing Scheme manager on the back of an envelope, referring to the person’s medication (though not detailing them) and recent medical history. A copy of a letter dated 11/1/08 confirmed the home could meet the person’s needs. A health professional commented that information passed to the Home is not always passed on or recorded in a way that makes all staff aware. Feedback was given regarding two people living at the Home who were admitted for intermediate care meaning that their aim was to go home. There was some evidence that they might not be receiving appropriate care. Due to time restraints this was not inspected but feedback was given to the manager to investigate and contact the relevant services as necessary. Management and Registered Nurses at the Home were not clear about what category people living there were classed as; such as ‘Nursing’ or ‘Residential’. Therefore there were no clear boundaries of accountability as to when District Nurses should be involved in care rather than the nurses at the Home. Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People’s health and personal care needs are not consistently met putting them at risk. Privacy and dignity is not always well promoted by staff meaning that people cannot be confident that they will be respected when receiving care. Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 13 EVIDENCE: We looked at the care plans of nine people. Each of these was written in at some length. They contained evidence that each person had been assessed to determine their physical care needs once in the Home. This includes assessing and devising a plan of care relating to their risk of developing pressure sores, of falling and of becoming malnourished. However, in some cases information about how to meet individual care needs was insufficient and the delivery of care was insufficient to meet identified needs. Some relatives commented in the questionnaires that the Home ‘sometimes’ meets their relative’s needs, ‘sometimes’ giving them the support they need. Diabetic care was not well planned or well delivered meaning that people could be at risk. One person was prescribed tablets for diabetes. There was nothing on their care records about their blood sugar range to guide staff as to when the General Practitioner should be informed in relation to blood sugar readings. The care plan said if the readings were too high, medication might need adjusting. Sometimes blood sugars were not re-checked after treatment for low readings. People had routine monitoring for one type of diabetes. One person’s care plan said an annual check was due in April, but the April review of the plan only said ‘Continue with plan’. We then saw an earlier review stated the check was due in May but without explanation. We saw another person who has diabetes. Records show, and staff confirm, that this has been difficult to control. This person is prescribed different amounts of insulin based on what they eat and on their blood sugar measurement. However, records show (and we observed) that this person sometimes refuses to have their blood sugar tested. As staff still give insulin, this means they are giving this without knowing how much this person should have. We asked a member of staff why they had decided to give the dose they were giving on that day. They said because the person was bright and alert and had eaten all their breakfast. This person, apart from the time they protested about having a blood test, had been lying on the bed with their eyes closed. We watched this person being fed. We would estimate that this person ate half of their breakfast and this is what we heard the carer tell the nurse. Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 14 This person is meant to have everything they eat and drink recorded, so that staff can ensure they get enough to drink and so that their dose of insulin can be calculated. Nothing was recorded on this person’s food and fluid chart between 7am and 4.30pm. Previous fluid and food charts were variable in their content and on some days nothing was recorded. At 4.30pm this person had a dry mouth and appeared to be seeing things that were not there. We bought this to the attention of the person in charge. This person is cared for on a pressure-relieving mattress. Their care plan says they must be turned two hourly to prevent damage to their skin and the development of pressure sores. This person’s position did not change all day. At 4.30pm we asked the person in charge to address this immediately. Another person who needed a high degree of care was seen to be moved at least twice but their fluid and turning chart was not used even though they were at high risk. Another person living here is very breathless and experiences chest pain. We found that this person had not been given the medicine they are prescribed to prevent this pain for two days. Staff told us they were aware of this, that it had not been delivered to the home and that they were following this up. We checked again at 4.30pm to see if this medication had been delivered and it hadn’t. We asked the person in charge to address this immediately, which they did. However, when we checked the next day (with the records and the person in charge) we found that a dose of this medicine was not given until the following morning. Another persons’ care plan indicated that they had waited 4 days to receive antibiotics. Whilst we were talking with this person, they had an attack of severe chest pain. They could not reach the medicine that relieves this. They told us where it is normally kept, but it was not there. We found it in a drawer. This person took this medicine and felt immediate relief. Staff we spoke with did not know that this person has chest pain and therefore did not know what to do if this happened. This person should be cared for sitting up to help their breathing. They lay semi-recumbent in bed until at 4.30pm we asked staff to sit them up. This person wears a device to catch their urine. We checked this at 4.30pm and found the bag stretched taut with urine. It had not been emptied all day. We informed staff on duty of this. We looked at the care plan of another person who experiences pain associated with a medical condition. Records and discussions with staff and relatives show that the relief of this person’s pain is not always happening as quickly as it could. Four carers were unaware of what medical condition this person had and therefore did not appreciate the degree of pain that the person was experiencing. This issue was addressed with the nurse in charge and the Director or Operations during the inspection. Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 15 We asked four staff if they read the care plans, which detail the care to be given. They said they do not. We asked how they got the information they need about how to meet peoples’ needs. They told us they are told at the beginning of each shift. We listened to this exchange of information at the beginning of the shift. Staff were given some information which mostly related to basic hygiene and breakfast needs. Staff were not given sufficient information to be aware of the care to be given, particularly also because care plans are not always read. Some relatives commented in the questionnaires that staff ‘sometimes’ or ‘usually’ had the right skills for the job. One response stated that staff ‘always’ had the right skills. Staff were told that they needed to tell the nurse in charge how much one person had eaten. When we spoke with them they thought they had to do this because some people get diarrhoea and vomiting, and not because this person has diabetes. Essential checks on some people were not consistent and put them at risk. Risk assessments for manual handling, falls, skin condition and turns were not completed for long periods in some care plans even though they had been reviewed monthly. Some people were already assessed as being at risk previously. One relative commented that they had concerns about the skills of the carers who may not notice changes in skin integrity or report to nurses. One person was found to have a dressing that needed changing but staff were not aware of this. When informed the manager dealt with this straight away. However, reviews for a care plan for someone prone to aggressive outbursts, did not reflect the outcome of care, with staff writing ‘No issues’ or ‘Nothing to add’. A recent review for someone’s moving and handling care plan did not reflect they had had two falls since the last review. Where care plans had been crossed out, this was not signed or dated, to show when the change in care occurred. We noted that there were night care plans but that these were evaluated by day staff, which may not ensure that these are accurate. Baths were not well recorded. Care notes said someone did not have their bath because they were already up and dressed; this person had told us they liked to be up early, and they were up before the day staff came on duty on the day of our visit. There was no subsequent entry about their bath, so it appeared they had not had a bath for at least 4 weeks. Their care plan said they were to be offered a bath every week, and their leg bag was to be changed when they were bathed. Whilst there were clear records that their catheter was changed at intervals, there was no record that their leg bag had been changed weekly. Two relatives were concerned as they thought that their relative had not had a bath or hairwash for 6 weeks. The manager explained that they had had a strip wash every day, but this was not clearly recorded. They knew that this person generally would say no to everything. Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 16 The relatives said that if their pain was controlled they would be able to have a bath and hair wash with encouragement. A separate relative survey stated that ‘my relative can go weeks without a bath, a bowl in the room would help and hand towels and flannels are rarely there’. Care records showed multidisciplinary team involvement such as the Community Psychiatric Nurse, with the care plan updated after their visit. However, a health professional said that actions were sometimes not passed on to staff to ensure that they are carried out. For example one person was supposed to be regularly practising walking but this was not happening. Provision of fluids and diet for people who are unable to help themselves is poor. Fluid charts for people with complex needs were not filled in properly and staff were not clearly checking whether these people had had enough to eat or drink. Mouth care equipment was not seen to be available for those people needing higher levels of care. One person was left with a mouth full of sticky bread and no teeth in and another person was very dry. There were no recommended total fluid targets on fluid charts or in care plans so that staff would know how much they should be having a day. One person whose care plan indicates the use of ‘thickener’ for drinks due to ‘swallowing problems’ was not having this. Checklists in one lounge included afternoon drinks rounds but there was no reference to morning rounds. We saw two people were given a drink with their breakfast and again after they had been helped to a lounge armchair after the meal. However, one person who was given their breakfast in their armchair only received one drink – with their meal. Some people told me they got a midmorning drink. Jugs of juice and glasses were available in both lounges, although we noted these were not offered to people in one lounge during the morning we spent there. Peoples’ care notes included ‘nutritional profiles’ – which included their dietary likes/dislikes. Care records showed care staff had arranged for the activities staff member to talk to one person, for whom they had concerns about their weight changes but had a difficult relationship with, about their dietary preferences, which is good practice. These were then forwarded to the Operations Manager. Staff had noted in a recent review that another person was losing weight despite appearing to eat well, so this had been reviewed their care plan and liaised with the kitchen about the person’s diet, which is good. People sitting in one lounge were wearing clean clothes and their personal grooming had been attended to. One person was pleased that they had given themselves a shave (part of their care plan), and staff commended them on their efforts in a supportive way. Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 17 However, one person was in need of personal care by lunchtime but was taken by staff to the dining table without being given this assistance although it was obvious. We spoke to the staff about the person’s needs to ensure that care was given. One relative said that their mother was looked after very well and was clean and tidy. Another said that they were satisfied with the care, their relative being clean and contented. They wished to give compliments to one and all. Another relative felt that needs were looked after well. Continence assessments have all been completed and appropriate equipment is available. People confirmed staff were generally polite, they knocked on bedroom doors before entering, and used people’s preferred names although a domestic did not seem aware of privacy issues when going in and out of rooms. Staff in one lounge engaged well with people at a superficial level, telling them they were leaving them after assisting them and when they would be back, for example. A staff member asked people having breakfast if it was okay if she took a chair from their table, waiting for their response before removing it. Staff engaged with and reassured one person expressing confusion at the end of their meal. There was less social interaction, however. On one occasion only we heard someone referred to as ‘a feed’. One carer took a comb from her pocket to comb someone’s hair in the lounge, which does not promote privacy and dignity as an individual. A health professional commented that the service could do more to promote privacy and dignity as on visits to the Home doors are sometimes left open during care. One relative felt that people at the Home were treated as ‘humans not baggage’. The health professional said that people do seem to be encouraged to manage their own medication but that that service could do more so that people are able to take on this task. A health professional commented that standards of nursing care were usually very good which means that sometimes care needs are met. They felt that the Home had been able to provide care for people with high needs when other Homes felt unable. They also said that the Home liaised well with Social Services and tried to improve when there were placement problems. We also looked at the storage arrangements for medicines and found that some of the cupboards did not meet the requirements for the type of medicine stored in them. This had not been raised at pervious inspections and the Home immediately arranged for this to be addressed. Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 18 We also found that for one person prescribed a medicine to be given in the event of a seizure that there was no plan of care to ensure that they would receive consistent care irrespective of which members of staff were on duty. We also found that when people were prescribed variable doses of medicines that the actual dose administered was not always recorded and there was also no clear guidance available to staff on how they were to make the decision about the quantity to be given. Whilst some members of staff were able to tell us how the decision about the dose to be given was made, it was not the same as other members of staff spoken to. Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 19 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 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 peoples’ 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 all people living at the Home receive a balanced diet. EVIDENCE: This home has a dedicated activities co-ordinator who works 22 hours each week. This person is very popular and tries to see everyone who lives here on most days. She organises activities and spends time with people who are unable to join in with the activities. She makes sure people get their post and their daily newspapers. Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 20 During the first day of this inspection this person led a poetry session that about 10 people attended. The way this was conducted generated genuine interest, discussion and engagement. A carer gently encouraged one person to attend offering to read from a book that they knew the person liked. On the second day, this person was organising a cream tea, which people were really enjoying. An activities newsletter tells people what activity is planned every month such as trolley shop, craft, music and quizzes etc. A recent Easter bonnet parade was successful with 14 people enjoying the event. One person’s care notes said that when the person had declined to attend the home’s harvest supper, they had been taken the harvest supper in their room. Activities notes showed the activities organiser spent time with individuals who did not use the lounges or join group activities (taking someone shopping for nail varnish, regular chats in their bedrooms, detailing what they talked about, etc.). However, this is obviously limited by their 22 hours per week. One relative said that the person living at the Home goes outside if the activities organiser is on duty but not otherwise. The Home said that staff do take people outside when they can and people have been able to access the grounds and patio in good weather when staff are available. The Home is extending activity sessions to the weekends and has had some successful sessions using carers, which is good. Some people at the Home receive aromatherapy sessions from an external therapist, which they enjoy. Visitors and contact with relatives and friends is encouraged and they are invited to any social events at the Home. People may have telephones in their rooms if they wish. Care staff have now been allocated to the lounge to spend time with people during activities. This is good practice. The Home felt that it was a good way to introduce carers to the importance of activities and to help carers with their English conversational skills and understand social needs as the majority of carers on duty had very limited English language skills. Meaningful social interaction with people with higher needs was poor from all care staff. In one lounge, we saw staff greeted and chatted briefly to one person who was cheerful, responded to them and knew some by name. However, another person was only spoken to by staff instructing them when undertaking a care activity with them – walking them to the table – or for the purposes of serving them their meal. There was no social greeting or engagement, other than a ‘Bless you’ when he sneezed. The person spent their time asleep. Two other people in the lounge were not spoken to at all other than during care. Three people in their rooms did not have any meaningful engagement with anyone all day. In contrast people spoken to who were more able were very happy at the home enjoying watching the television in their rooms and regular banter with staff. Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 21 We saw during our visit and from daily care notes that one person was supported to enjoy their interests as noted on their admission to the home. They had been offered (and accepted) a room where they could have a view of a bird table, as they had asked. We noted that staff had recorded denominations in peoples’ care notes, but not included whether they practised a faith, any accompanying spiritual needs, etc. One person’s daily notes said they had enjoyed the church service on one day in the last month, but their care plan didn’t include their spiritual needs. Another person’s notes said, on admission, that they were a regular member of a church, but their subsequent care plan did not reflect this or consideration of their faith needs. A staff member said that sometimes people who would like a specific activity are not brought down to the lounge in time meaning that they miss out. Two people were sitting in one lounge when we went there at 8.10am. One was asleep; the other confirmed they liked to be up at that time. Their care plan said they should be left with a call bell, but they had not been given one in the lounge (it was still on the wall behind their chair). At breakfast we heard people being offered choice of brown or white bread or toast; they were offered more toast, but not a second cup of tea. Some people served breakfast in their bedrooms were given individual pots of tea. One staff member said they always plated the meals in one lounge because people there would be unable to do this themselves. In the main lounge all plates were plated up with staff dishing up vegetables for them. One person in their room said they preferred to stay there and didn’t want to mix. They said the staff were always around though, and they fitted in with the residents (rather than residents having to fit in with them). One relative commented that there was a good selection of activities. Another relative commented that activities add greatly to peoples’ lives at the Home and are greatly appreciated. One person told us there were regular drinks rounds, with sandwiches available on the night drinks round. They said the food was generally good. Another described it as ‘normal’, confirming there were regular drinks rounds. On one floor, care assistants ensured everyone got breakfast with their particular preferences taken into account (someone not wanting to get up yet, someone ‘wanting to come through for their breakfast now’, warm milk for A, ‘Put lots of toast on because B and C like lots’– and both accepted offers of more toast subsequently; ‘There’s a tray with a full jug of milk, because D likes plenty’). Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 22 Two staff confirmed there was enough food available for people living at the home, such that they could be offered ‘seconds’; one commented there was usually some left over on the food trolley. Staff sat with individuals needing help to eat or drink at mealtimes, taking time to assist them at a suitable pace, but there was limited engagement. We saw one person became very restless just before mealtimes, and was settled once he had been given his meal. The carer helping him asked if he had had enough to eat, before leaving them to freshen his face after the meal. People needing help were served after more independent people, getting their meal 45 minutes later in one case. Two people were not washed after being fed and one relative commented that this is what the Home could improve along with people having clean clothes. Another relative said that people were ‘often in the same clothes’. We were unable to check this during the inspection but the Home have been looking at the issue of whether some people living at the Home have an adequate supply of clothe and a clothes party was held recently. Staff do approach relatives to ensure that people have enough changes of clothes and have had a reasonable response. There is a four-week menu showing usual English fare (roasts, liver, etc.) and mainly soft puddings (ice-cream, semolina, jelly, packet fillings). There are bowls of fresh fruit available. We talked to people about the food. Some said it was very bland and lacks variety. One person would like to have pasta, curry or something a bit more exciting. The cook agreed that the food was ‘a bit boring’, having been the same for a long time. One person said they wanted their own salt and pepper because they did not think meals are seasoned enough. They said they had asked care staff to bring this, but that they didn’t because they had forgotten. Tables did not have any condiments on. We looked at the menus and saw that the meat in cooked dinners (served at lunch) is usually either chicken or mince. We saw that on both days that this site visit was conducted that chicken was served, in a casserole one day and roasted the next. We were told that each cooked meal is made up of one fresh vegetable and two frozen. We looked in the kitchen and saw that there are fresh vegetables and fruit available. The cook bakes cakes on the premises that are served for tea/supper. People enjoy these, but also say that the soup and sandwiches served for tea/supper can be a bit repetitive. The manager said that they are currently doing a food quality audit to try to ensure that food variety improves. Those people who require meals that are very soft or minced have all the different parts of each meal minced and served separately as is good practice. However, their meals may be more repetitive as they eat for supper what was on the menu for dinner the day before. This means they might get four meals of chicken in a row. A staff member wrote to us saying that ‘half the residents don’t get Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 23 asked what they want’. Most people spoken to couldn’t remember what was for lunch or whether they had been asked or not. None knew that they could ask for an alternative if they wished. Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 24 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is poor. 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 peoples’ complaints are poor. People living at the Home are not protected from abuse by sound procedures and practices, which puts them at risk of harm. EVIDENCE: The general attitude of people spoken to at the Home and relatives is that if they make a concern/complaint known to staff at the Home it is then not actioned in a timely way if at all. We were told of some issues that had been reported to staff but these were not recorded as entries in the complaints log or acted upon. Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 25 The complaints log for 2008 had four entries. One was from us (13/3/08). One was from an agency about care delivery, which had resulted in a memo to staff reminding them to use correct manual handling and infection control procedures. One was complaining at a 45 minutes wait for the stand-aid one evening (27/3/08); a note in the file said it was broken and to be chased up on 31/3/08 if not repaired. On 15/04/08 it was still out of action, awaiting a part. We spoke to one family who feel their complaints have not been taken seriously. They say they have spoken to all the nurses about their concerns relating to the care of their relative and whilst something might happen immediately, this is not sustained. On the day of this inspection, this family shared their concerns with us and with the Director of Operations. We spoke with them later and they were very happy with the outcome. One relative said that they did not know how to make a complaint but that it was a caring home. Another said that they did not know how to complain but that the Home did sort things out straight away if asked. Another relative had asked several staff the same things but that the issue had not improved and had obviously not been communicated or recorded. The issue was found to be upheld during the inspection. However, there is a clear complaints policy near the front door including how to contact the Provider. One relative had wondered whom they would contact to complain as they had a key-worker before but they had left. Someone living at the Home commented that staff did not always listen to them stating ‘staff are not always interested if I’m not happy, just say they will pass on a message and I never hear any more about it’. One person had issues with the laundry with items going missing. They had told the manager but this was not recorded or actioned. One relative commented that they got on well with staff and can discuss anything. Most relatives ticked on our surveys that they knew how to complain. A health professional said that staff try to respond to concerns but due to demands on their time and low staffing levels they are not always able to put into practice agreed actions. During this inspection we also used information received from 6 different sources including health professional, member of the public, ex-staff member and relatives who all raised concerns about care delivered at the service such as manual handling practices, pressure area care, cleanliness and call bell responses. Two safeguarding meetings have been held recently due to an alert from a member of the public rather than the Home and are ongoing, involving the multidisciplinary team. Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 26 The manager tells us that some staff have had training in how to safeguard people from abuse. We spoke with four members of staff about this. Some told us they had watched a video but could not remember what they had learnt. When we talked further about this one thought they had learnt to ‘be careful with residents’ and another that they had to be careful not to hurt people when they were handling them. We asked staff what they would do if they saw someone shouting or being hurtful to someone who lived here. Their response was not in line with locally agreed multi-agency policies and means that some people might be left at risk of harm. The fourth complaint recorded was the written complaint indicating rudeness and rough handling by a night nurse one night. The manager’s reply was dated 8 days later and said she had spoken with the nurse. There was no evidence of this in the supervision file or in the staff member’s file nor evidence that a safeguarding alert had been considered. This could put people at risk. A care plan recorded that one person was prone to bruising and this was then noted well on a body map and reviewed regularly, which is good practice to keep people safe. Bed rail risk assessments for two people with limited mobility or risk of falling indicated they would not benefit from them, and there were none on their beds. Although one had fallen, there was no evidence that either had fallen out of bed recently and bed rails were used appropriately. Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 27 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 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 within the home is satisfactory meaning that generally people live in a comfortable environment. Cleanliness within the home could be improved to ensure that people are safe and protected from infection through good practice. EVIDENCE: We spoke to staff about how they prevent the spread of infection. They told us they had been shown when to wear gloves and aprons but had not been shown how and when to wash their hands. Only 6 staff have had formal training on infection control. Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 28 One person has been admitted to the home with an infection in a wound, which staff are dressing. A relative told us they had told lots of people this but didn’t think that staff were passing this information on to other staff. We checked in this persons care plan and the existence of an infection was not recorded. We checked with the manager who had not been told by the staff that this person had an infection. People who we asked said their bedrooms and facilities (heating, lighting including for reading in the evenings) were satisfactory. Some had raised toilet seats in their en suite. Décor in the Home has improved since the last inspection and some rooms have already been freshened up. The communal areas were pleasant. Some chairs and tables had been re-arranged to create a comfortable area. Bins were closed and not overflowing and the outside area was tidy. There was an odour generally in the first floor corridor (possibly urine mixed with the smell of cleaning products). Some bedrooms smelt of urine and the windows had not been opened even though it was a hot day. A domestic confirmed the night staff clean the lounges; she said she would be shampooing the lounge carpet the next day. There are cleaning programmes in place. However, the room of one couple was dirty. One relative was concerned about the hygiene at the Home such as dirty toilets and felt that they should not have to raise this with staff. Two rooms had dirty bed linen even though the beds were made, we informed staff. Furniture did not seem to be always moved to clean under. One relative said that the ‘chips under the chair are from last night’. One person said their bed had not been made for three days. Another relative said they often visit in the afternoon and the bed is not made. One person said that the domestic did not move furniture and they had never seen such a quick ‘whip round’. Staff wore specific coloured disposable aprons and gloves when serving food. We saw stocks of disposable gloves were available around the home. However staff wore the same aprons from room to room when giving care. One room had no soap in dispenser and the hand rub dispenser was broken. This person was receiving high-risk medical care using equipment. This was addressed immediately when we told the manager. One person’s specialist armchair had damaged padding so that the bare wooden frame of the chair was exposed. The manager confirmed that a new chair was arriving that week although the chair had been in this state at least since the last inspection and the wood should have been covered for safety. The Home said that attempts had been made to cover the chair and unfortunately the delay had arisen from an unsuitable chair arriving which had to be re-ordered. Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 29 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 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 peoples’ needs, which puts them at risk. Recruitment systems are not robust therefore not ensuring that people living at the home are protected. EVIDENCE: Until recently the home have, due to decreased staffing numbers, been using agency care workers. On average there are 2 qualified nurses on duty with 7 carers in the mornings and 5 in the afternoon/evenings. Unfortunately, two staff were off sick on the day of the inspection, one being a Senior Carer and the other and experienced care assistant. A number of new staff have now been recruited. However, this does mean that a lot of inexperienced staff are now working at the home. We found on the day of this inspection that many of these staff were working together without additional support or supervision. On average four new staff out of seven are on duty. For example during this inspection 24 people were being looked after by a Nurse who has worked at the home for a long time, by the manager and by three carers. Two of these carers had only worked at the home for a few weeks. They had not started an induction Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 30 training programme and their first language was not English. We were told that these two carers need a lot of supervision and that there is not always time to give this. We raised significant concerns relating to the standard of care and associated risks with the manager during this inspection. We required her to take action immediately (as detailed in the section Health and Personal Care). We talked to staff and the manager about training. We found that some staff had been shown very basic skills such as how to use moving and handling equipment and when to use aprons and gloves. In addition, although it is planned that induction will in the future be based on ‘Skills for Care’ as it should be, those staff who have had an induction did not have one of this type. The manager reports that some staff do not have good enough English to undertake this type of induction and that she is devising a pre-induction training course to suit their individual needs. Therefore these carers will not complete induction training within the recommended 12 weeks. A staff member wrote ‘we are always short staffed and foreign staff don’t listen or understand orders, nor does the service user understand them’. One staff survey response said that ‘on my first day I was given an induction of 3 hours and then I shadowed someone for 3 days. I wasn’t shown how to use the equipment properly or any moving and handling.’ The manager also told us that they are about to start training all the staff again. This is because the records relating to training given to staff cannot be found. We were therefore unable to fully inspect training but generally staff have not received any specialist training such as palliative care, wound care, dementia care, nutrition or diabetes care for some time. We were told that as most staff were new only one carer has a National Vocational Qualification (NVQ), 50 is recommended. People we spoke with say that staff are very busy and do not all have the skills needed to deliver care. We were told that staff say they will come back to do something and then forget. One person said ‘they forget a lot here’. Another person said ‘you can have the best care plan in the world but if the staff don’t read or understand it, it’s useless’. A health professional felt that there was a high staff turnover and that some appear to lack experience of providing care. They said that staff were dedicated to their jobs but that grievances had been aired in front of people living at the Home causing problems. A staff member responded to the questionnaire saying that they were only sometimes given up to date information about peoples’ needs and that training Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 31 was not given to help them. They felt that they had no support from management and that there were never enough staff. One relative told us that their relative had hurt themselves having fallen in the lounge when there were three carers there. Another relative told us that their mother often drags her wheelchair by foot to the toilet unassisted from the lounge and has fallen in the toilet as a consequence. This could be a result of carers not knowing peoples’ needs when in the lounge. One person said the staff were ‘absolute darlings’ or at worst ‘very very nice’. Another said the day staff were ‘wonderful – they do everything you want’. They said staff were always around, although there was sometimes a delay in call bells being answered because staff had to attend to frailer people. Other people were accepting of the fact that there might be a delay because staff were busy or on their breaks. Staffing was the same at weekends as during the week. But the staff often told them they were short-staffed. They were less happy with the attitude of some night staff, but said things had improved since they made a complaint about this. People spoken to felt some staff from overseas didn’t understand them. They thought the staff team was quite stable, with a core of staff who had worked there for years. ‘One is hilarious they make us all laugh…without stopping working.’ We observed good team-work amongst carers at breakfast in one lounge, ensuring everyone got breakfast with their particular preferences taken into account. Another person felt there were staff changes however, and said they had to explain to staff what help they needed. Call bells were silenced promptly during the morning on both floors. There was more of a delay during the afternoon. Relatives reported improvements in the prompt answering of call bells recently but still comments included that they ‘wait too long’. Two people waited almost an hour after finishing their breakfast before being offered help to leave the dining table. Care staff seemed under pressure to get crockery, etc. back to the kitchen first (although kitchen staff had prepared the dining room for breakfast). One person needing assistance was waiting at least 45 minutes at the dining table before they were served their lunch. People who did not require help were given their meals first. Another person felt there were staff changes however, and said they had to explain to staff what help they needed. Relatives commented consistently that there were language problems. ‘In the evenings we only see foreign staff who cannot communicate with my relative who finds it frustrating. They often do not get the care and attention needed’. ‘The foreign staff do not understand their needs or fulfil them’. Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 32 One relative commented that agency staff communicated in a much more appropriate way with people living at the Home whereas there were issues with permanent staff relating to language and culture. Three of the carers spoken to had very poor English communication skills. We were told that two carers on nights added to rota 14/4/08 – were from another home owned by the company. These staff are to help provide stability in night team until permanent staff are recruited, which is good practice. We looked at staff recruitment files for three carers and for one domestic observed during our visit. All had signed application forms with health declarations and photo identification. The care staff had relevant care experience. Protection Of Vulnerable Adults First checks had been obtained for three of the five before they started employment, with Criminal Records Bureau (CRB) disclosures since obtained for two of these; two had CRB disclosures obtained before they started employment. One relative felt that the carers were fantastic and knew what to do for their relative. Another relative said that the Home was fortunate to have such a friendly, efficient and happy receptionist. This makes a nice welcome for people entering the Home. Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 33 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is poor. 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: Unfortunately there have been barriers to the Home’s development. The management at the Home has been unstable for some time and there has been no registered manager. There have been three managers in the last year and the locality of the Home poses problems for local recruitment. Staff turnover has also been high with a lot of changes in management systems leading to confusion. Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 34 A relative commented that it would be lovely to have a permanent manager to bring the Home back to the standard that it enjoyed previously. A staff member responded anonymously to the questionnaire saying that relationships between management and nurses were very bad with staff members regularly crying. This does not refer to current management as an acting manager and recently been put in place. Throughout the inspection management were extremely receptive to our findings and tried to improve issues as soon as they could if possible on the day. Staff say there have been improvements in the home since the last inspection. They say that there are more staff although the skill mix is poor. They felt that management are monitoring what is happening more. They felt that the Operations Manager and the new manager were working hard and that they appreciated having someone take an interest in their work. Management now work regularly on the floor and are ‘visible’. The Operations Manager is currently working full time at the Home and the new manager has good experience in managing a ‘good’ home. They also say that they would ‘like more staff who know what they are doing and can get on and do it’. Efforts are being made by management to address issued, some identified in this report. The fire policy is being translated into appropriate languages to help staff. A health professional commended the management involvement in a recent social work review. Staff are being encouraged to exert more leadership on the floors and it was good to see that handovers did include allocating carers to drink rounds and checking the lounges. Staff said that they felt that they were told to supervise the new carers better but did not know how they would find the time to do this. Some new equipment has been obtained such as a special bed and moving and handling equipment and re-decoration programme is being planned. A quality assurance programme is in place and the manager is working to implement this. This will include relatives meetings. Comment cards were on display at the reception and the ground floor entrance, since April 1st 2008 but the Home said that they had not yet had a response through these. These cards invite comments on all aspects of care and management at the Home. However at the time of the inspection the quality assurance and monitoring system had not been implemented to enable the Home to clearly measure success in meeting the aims stated in the Statement of Purpose. The Home has no annual development plan of systematically planning, actioning and reviewing service delivery and peoples’ satisfaction. There has been no full quality assurance survey feedback recently for the Home to be able to develop care plans accordingly. Requirements have not always been addressed fully following inspections. Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 35 They are aware of the staff skill mix issues and are trying to use staff from another home, sending two carers to that home for training. Additional staff are on duty at key times. There were few records or evidence of disciplinary action or of formal staff supervision. The new acting manager had begun supervision sessions having only started work at the Home since Easter and has seen 6 carers and 3 ancillary staff recently (but no nurses), which is good. However, despite efforts people at the Home are at risk in a number of areas, as they cannot rely on staff having the skills to meet their health and personal care needs or be certain that these are clearly identified. Peoples’ finances are well looked after and organised. The administrator confirmed the home’s staff are not appointee to anyone living at the home – people had their own representative, or in a minority of cases Devon County Council acted as receivers for individuals. No monies were held for people living at the home. They were billed in arrears for any expenses they incurred, with details of transactions sent to the representative with the bill. People never have to go without things that they wish in relation to finances. Staff receive some manual handling training. However, we were told that staff do not seem to always understand this and sometimes use methods that they should not. This has included one person using a hoist alone when there should be two staff doing this and staff lifting a person manually when they should be using a hoist. A professional person who visited the Home said that they saw poor manual handling techniques and a lack of reassurance given to a person who was blind and confused. An agency staff member said that staff often use stand aids inappropriately instead of a hoist. One person at the Home said that staff did not use a hoist sometimes because ‘it is quicker not to’. All manual handling training is presently in-house. Whilst in the lounge we saw two staff handle someone appropriately whilst hoisting them from armchair to wheelchair, including to fit their sling and then remove it, engaging with the person as they did this. They fetched the right footplate when one was found to be wrong. Another person was encouraged appropriately and given the time they needed to stand himself from his chair without being handled by staff. Staff are also said to be transferring people from wheelchairs into comfortable chairs more often as they wish. Two people said the home’s handyman maintained their wheelchairs. Care plans included detail of the hoists to be used for each person who needed one. One person had a care plan to ensure their wheelchair was properly maintained. Bath water temperatures were recorded to ensure that when people had baths they were safe. Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 36 A record was kept in one lounge of checks made by staff (generally half hourly). Some days the recordings ceased at 3-4pm; other days they were continued until 8pm. There have been some falls in the lounge and this should be monitored to ensure that people are safe. The Home has had a visit from the Fire Department and are addressing some requirements from them. Staff have recently received Health and Safety training and all maintenance of equipment is up to date. Storage of Substances Hazardous to Health was secure. Environmental Health visited recently and issued a Hygiene Improvement notices due to a lack of compliance relating to repair work in the kitchen area. They also required that improvements are made to the level of cleaning in the kitchen and storeroom. Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 37 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 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X 3 2 X 1 Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 38 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 You must ensure that all initial assessments be comprehensively completed prior to the person moving into the home and that assessments are reviewed to ensure that individual needs can be met. You must get a named service user’s medicine and administer this as prescribed. You must ensure that the provision of care relating to diabetic care for a named person needs to be reviewed. These were issued as immediate requirements You must ensure that the Home promotes and makes proper provision for the health and welfare of people living there and for their care, treatment and supervision. Unmet previous inspection 12/03/08 Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 39 Timescale for action 15/06/08 2. OP8 12 16/04/08 3. OP9 13(2) Arrangements must be made to ensure that all medicines are stored in accordance with the current regulations Arrangements must be made to ensure that the actual dose administered is recorded and that there are clear guidelines on how to determine what variable dose is to be given You must ensure that the Home is consistently conducted in a way, which respects peoples’ privacy and dignity. Unmet previous inspection 12/04/08 18/07/08 4 OP9 13(2) 17(1) 18/06/08 5. OP10 12 (4) 15/06/08 6. OP16 17 (2) Schedule 4 22 You must ensure that any complaints are recorded, investigated and action taken as necessary. Unmet previous inspection 12/04/08 15/06/08 7. OP18 13 6 15/06/08 You must make arrangements, by training staff to prevent people being harmed or suffering abuse or being placed at risk of harm or abuse. Appropriate training must to be given to all staff to ensure adult procedures are followed and people are protected. Unmet from previous inspection 13/02/08 [Original timescale: 5/10/07] Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 40 8. OP26 13 (3) You must ensure that the Home makes suitable arrangements to prevent infection, toxic conditions and the spread of infection at the Home and that the Home is kept reasonably clean. In order to meet the diverse and complex needs of the people living at the home, you must ensure that sufficient and suitably competent and experienced staff are on duty. Previous timescales of 13/12/05, 1/07/06 and 26/12/06, 5/09/07 unmet. Although staffing numbers have improved, there are not always sufficiently competent and experienced staff on duty who have the knowledge to meet peoples’ needs. 15/06/08 9. OP27 18 1 a 15/07/08 10. OP33 24 11. OP38 13 5 You must establish and maintain 15/06/08 a system for reviewing and improving the quality of care: this refers to implementing an effective quality assurance system. 15/06/08 In order to promote good practice and protect people living at the home, you must ensure that suitable arrangements are in place for a safe system for moving and handling people. This includes staff training. Unmet previous inspection 12/03/08 [Original timescale: 5/10/07] Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 41 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP8 Good Practice Recommendations It is recommended that health and personal care be delivered in a more individualised way focussing on person-centred care. Staff should ensure that people’s personal care is maintained to a good and expected standard. All staff should promote good communication with other staff, health and social care professionals. Unmet from previous inspection 2. OP10 It is recommended that people’s dignity is maintained by ensuring that staff assist people to use the toilet when needed. Unmet from previous inspection 3. OP12 It is recommended that you ensure enough care staff support and supervision during large group activities on a regular basis and are aware of peoples’ needs. Unmet from previous inspection 4. 5. OP26 OP28 It is recommended that the home is kept free from offensive odours. It is recommended that a minimum of 50 of care staff should be trained to NVQ Level 2 or above. Unmet from previous inspection. Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 42 6. OP30 It is recommended that there is a clear, structured induction and appraisal system for staff, which meets Skills for Care requirements. Staff should also receive appropriate training to help they care for people with different conditions such as palliative care, Huntington’s disease and dementia. Unmet from previous inspection. 7. OP33 It is recommended that improvements be made in response to the home’s quality assurance results. It is recommended that all staff receive formal staff supervision at least 6 times a year. 8. OP36 Culm Valley Care Centre DS0000037291.V362447.R01.S.doc Version 5.2 Page 43 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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