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Inspection on 26/04/05 for Culm Valley Care Centre

Also see our care home review for Culm Valley Care Centre for more information

This inspection was carried out on 26th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The Home has a good manager and staff team who are keen to improve standards and work hard to achieve any requirements and recommendations. Residents spoken to felt that the staff had built good relationships with them and work hard to improve their quality of life. Staff are seen to care for all residents whilst promoting independence and this is supported by documentation. The Home`s admission assessments are very detailed and give a holistic picture of the resident as an individual with all recorded information matching what the residents said on the day of the inspection. The Home has a full activity programme on a weekly basis with an accompanying newsletter. Documentation also shows that residents unable or not wishing to join programmed events are accommodated. Personal events are celebrated such as residents` birthdays. The Home also has a full staff training and induction programme, which includes any specialist medical conditions, which residents at the Home present with or which staff feel they wish to update. 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.

What has improved since the last inspection?

The Home only received one requirement and 5 recommendations during the previous inspection; the majority of these have been addressed. All bathrooms and en suits now have appropriate locks and the second floor smells fresh. A quality assurance report is being compiled to send to CSCI to ensure that residents` views are being taken into account.

What the care home could do better:

Residents` care records still need to be improved to ensure that all health care needs are met consistently and that care given is evaluated properly and kept up to date. Residents` spiritual needs are not being addressed or documented. The Home must ensure that residents` health and safety is not placed at risk and that the finance records for residents` monies are clearer. All staff must have regular mandatory fire training.

CARE HOMES FOR OLDER PEOPLE Culm Valley Care Centre 10 Gravel Walk Cullompton Devon EX15 1DA Lead Inspector Rachel Doyle Announced 26 April 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 S37291 Culm Valley V211005 260405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Culm Valley Care Centre Address 10 Gravel Walk Cullompton EX15 1DA 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 Mrs Patricia Quick CRH N Care Home with Nursing 56 Category(ies) of OP Old Age [56] registration, with number PD[E] Physical Disability over 65 [56] of places Culm Valley Care Centre D54 D06 S37291 Culm Valley V211005 260405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1:- Notice of Proposal to Grant Registration staffing/environmental conditions of registration issued 27/11/2001 2:- Registered for up to 6 people Intermediate Care (50 years and above) 3:- This variation allows for the admission of one named person, under the age of 65 in the category PD Physical disability. 4. The maximum number of placements including those of the named service user will remain at 56 5. On the termination of the placement of the named service user 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. Date of last inspection 23rd November 2004 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 S37291 Culm Valley V211005 260405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out the announced inspection due to the size of the Home. The inspection started at 10.00 until 15.45. The manager was available throughout the day and all staff were very helpful and welcoming. There were 43 residents living at the Home on the day of the inspection, including 7 for intermediate short-term care and 1 who was in hospital. The inspectors spoke to 12 residents in depth, 3 having intermediate care who were case-tracked. They were all very positive about the staff and life in general at the Home. They also spoke to 3 relatives, a visiting Community Psychiatric Nurse and Occupational therapist, 2 Registered General nurses and 2 carers. CSCI received 4 comment cards from relatives and 5 from residents, which were positive overall. What the service does well: The Home has a good manager and staff team who are keen to improve standards and work hard to achieve any requirements and recommendations. Residents spoken to felt that the staff had built good relationships with them and work hard to improve their quality of life. Staff are seen to care for all residents whilst promoting independence and this is supported by documentation. The Home’s admission assessments are very detailed and give a holistic picture of the resident as an individual with all recorded information matching what the residents said on the day of the inspection. The Home has a full activity programme on a weekly basis with an accompanying newsletter. Documentation also shows that residents unable or not wishing to join programmed events are accommodated. Personal events are celebrated such as residents’ birthdays. The Home also has a full staff training and induction programme, which includes any specialist medical conditions, which residents at the Home present with or which staff feel they wish to update. 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 S37291 Culm Valley V211005 260405 Stage 4.doc Version 1.30 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 S37291 Culm Valley V211005 260405 Stage 4.doc Version 1.30 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 S37291 Culm Valley V211005 260405 Stage 4.doc Version 1.30 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, The initial assessment procedure ensures that accurate information is obtained prior to people moving into the Home so that care needs can be met on admission by fully trained staff. Residents receiving intermediate care are able to maximise their independence to enable them to return home safely. EVIDENCE: All 7 residents’ assessments looked at were very detailed and matched how the residents saw their needs and preferences. The manager or a senior nurse visits prospective residents at home or hospital as appropriate. All residents spoken to say that they or their families had been able to visit the Home prior to admission. Staff had received information and training in specialist topics such as Motor Neurone Disease and Dementia depending on residents’ assessed needs and there is good documented communication with other health care professionals. There were weekly meetings of a reablement team (including a physiotherapist). Staff learnt rehabilitation skills from more senior staff, on a one-to-one basis, rather than attending separate study days but a training session is being arranged with the physiotherapist. Senior carers were Culm Valley Care Centre D54 D06 S37291 Culm Valley V211005 260405 Stage 4.doc Version 1.30 Page 9 responsible for ensuring care advice from Occupational therapists was followed up and continued with the resident. There was a kitchenette where residents could make drinks if they wished to, and the Activities Co-ordinator held baking sessions. Community Occupational Therapists organised home visits prior to discharge. Various allied health professionals were fully informed when residents were discharged home. Culm Valley Care Centre D54 D06 S37291 Culm Valley V211005 260405 Stage 4.doc Version 1.30 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, 11 Whilst staff are knowledgeable and meet residents’ health care needs with other health care professionals, limited progress has been made to provide clear and care documentation to adequately provide staff with the information they need to consistently meet residents’ physical and spiritual needs. The medication at this Home is generally well managed apart from labelling and returns, which can potentially place residents at risk. Personal support is offered in such a way to promote and protect residents’ privacy, dignity and independence. EVIDENCE: Residents all said staff knew what practical help they needed and inspectors saw that staff were knowledgeable and attentive to residents’ needs. A visiting professional said the Home was caring well for someone with confusion. Three visitors said their relative always looked well cared for, whatever time of day they visited. Culm Valley Care Centre D54 D06 S37291 Culm Valley V211005 260405 Stage 4.doc Version 1.30 Page 11 Seven care plans were looked at. Some care plans were detailed but most lacked sufficient information or effective evaluations. Of three care plans for residents admitted for intermediate care, one was very detailed and two were not. None of them showed staff tried to meet spiritual or psychological needs, the only related entries being to note when visitors had called although staff have received relevant training. Care records for intermediate care did not show progress or re-evaluate abilities after admission (regarding mobility, continence or treatment of dry skin, for example). Medication records and procedures were generally satisfactory. However, items no longer required by residents were found, including a bottle of sleeping pills. Also, insulin pens were not labelled with the user’s details. This must be done, even when only one resident is currently using the stock. Culm Valley Care Centre D54 D06 S37291 Culm Valley V211005 260405 Stage 4.doc Version 1.30 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, 13, 14, 15 Social activities and meals are both well managed, creative and provide daily variation and interest for people living in the Home. Residents’ wishes are taken into account so that they can exercise choice and control over their lives. EVIDENCE: Designated activities staff organise a full activities programme, which is communicated to residents in a weekly newsletter. This includes gardening, art, topical television events, garden fete and games amongst others and residents who could not make it to the activity areas also had their social needs addressed and documented. Although one resident spent most of their time in their room, staff took them to organised events that the resident would enjoy. They also popped in regularly to see them while they were in their room. The housekeeper’s role also includes visiting residents on a daily basis to ensure that they are happy with services at the Home. Most residents said that staff are flexible, attending quickly if the call bell was used; all residents had call bells within reach. Relatives said that the Home communicated well with relatives (contacting them if the resident was unwell, or if they needed toiletries, etc.) and visiting was unrestricted. Care records included details of any callers a resident might not wish to see. Culm Valley Care Centre D54 D06 S37291 Culm Valley V211005 260405 Stage 4.doc Version 1.30 Page 13 Some residents who were in their bedrooms said they preferred to be there rather than in the lounges, saying that staff came in to see them regularly and they were not bored. They said that their visitors were made to feel welcome and two were taking lunch with the residents. There was a good variety and choice of meals provided and relatives and residents confirmed this. Meals are served in comfortable dining rooms and staff are attentive to residents’ needs. It was noted that two residents had health needs affecting their appetite, and had diet supplements provided. Culm Valley Care Centre D54 D06 S37291 Culm Valley V211005 260405 Stage 4.doc Version 1.30 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) 16, 17 Residents are confident that their rights are protected and that they are listened to and their comments acted upon. EVIDENCE: There is a comprehensive complaints procedure and complaints are acted upon properly and records kept. Staff said residents rights were discussed during staff induction. They were mindful of their right to choose where they spent their day, for example. An Age Concern volunteer was coming to the Home to help people complete postal vote application forms, although most residents spoken with were not concerned about voting. Advocacy had been accessed through Age Concern or the Motor Neurone Disease Society. There was information, displayed on notice boards, about a confidential helpline for carers. Notices around the Home invite visitors to speak to staff if they have any concerns. The manager said that there was an open door policy for complainants. Most residents said that they were happy to speak to staff if there was a problem and all had copies of the complaints procedure in their rooms. Culm Valley Care Centre D54 D06 S37291 Culm Valley V211005 260405 Stage 4.doc Version 1.30 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, 23, 24, 26 Residents are provided with safe, clean and comfortable surroundings in a pleasant environment although residents have not been given the opportunity to choose whether they would like to use an appropriate lock and key for their rooms. EVIDENCE: Residents were happy with their bedrooms and had personalised them with their own possessions as they wished. There are two large lounges and other quiet areas and a bright and open reception area. There is level access to the landscaped grounds and an upstairs patio area with pretty flowerpots and a bird feeder. Residents’ rooms do not all have locks and most said that they had not been offered. There were no risk assessments about this issue. Hand-washing and clinical waste disposal systems reflect good practice as observed and there were no offensive odours throughout the Home. All areas of the Home were clean and residents said that this was usual. Culm Valley Care Centre D54 D06 S37291 Culm Valley V211005 260405 Stage 4.doc Version 1.30 Page 16 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, 30 The number and skill mix of competent staff are sufficient to meet residents’ needs. EVIDENCE: The staff rota indicated that staffing levels were within agreed limits and sometimes over these numbers. There were adequate numbers and skill mix of staff on duty during the inspection. The staff team structure has been reorganised and staff said that in general the workload was more manageable and residents said that care had improved since then. There have been some staff off sick especially at weekends and the administrator is monitoring this. A relative said staffing shortages – usually due to people ringing in sick - were worse at week-ends but that they were willing to make allowances because staff would do anything as soon as they were asked. Relatives and residents described staff as ‘very good’, ‘very loving’, ‘affectionate’, and ‘caring’. Residents said that all staff were very good, and helpful. The proposed eightbedded extension for those living with dementia will be staffed separately. There are new computerised individual staff training files making it easy to see who has attended what training. The Home offers and facilitates a wide range of training including relevant specialist medical topics. Staff who do not attend mandatory training are chased up by the manager and reasons for their absence are sought. Culm Valley Care Centre D54 D06 S37291 Culm Valley V211005 260405 Stage 4.doc Version 1.30 Page 17 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) 34, 35, 38 Financial records relating to residents’ monies were not robust and did not safeguard residents interests or protect staff handling money or valuables. Residents receive care in a safe environment although not all staff have received up to date fire training, which could put residents at risk. EVIDENCE: Lockable facilities for money or valuables are not provided routinely. The manager said the Home has a policy that all valuables are stored in a safe facility centrally (as opposed to residents keeping the items), but this was not seen to be included in written policies. A lockable facility is provided if residents want to keep small amounts of money in their rooms. No receipts are provided for residents when they hand items in for safekeeping. The manager said residents are given a copy of the property list, where such items are recorded but in practice this only happens if the resident specifically asks for a copy. Culm Valley Care Centre D54 D06 S37291 Culm Valley V211005 260405 Stage 4.doc Version 1.30 Page 18 There was a dedicated bank account for residents’ personal monies. Receipts relating to any one resident’s expenditure were kept in different places; rather than keeping them with the relevant resident’s record, they were stored according to the person making the charge to the resident (hairdressers, clothing company, etc.). Two signatures were obtained for any transaction, but these did not necessarily include the resident’s signature, even when they were able to sign for themselves. Thus although systems met minimum standards, they were not robust, and did not protect residents or staff handling money or valuables. The current Employers’ Liability certificate was displayed and there is a Financial and Development Plan, which would be available for inspection on request. There was evidence of investment in the Home such as on-going decoration and further extension plans. The manager said that they had an adequate budget and could discuss additional needs with the owner. Personal and environmental risk assessments were seen and appropriate action taken to minimise the risk. Fire equipment had been checked regularly. All staff were up to date with manual handling but not fire training. Culm Valley Care Centre D54 D06 S37291 Culm Valley V211005 260405 Stage 4.doc Version 1.30 Page 19 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 3 x 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x 3 3 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x x x x 3 1 x x 1 Culm Valley Care Centre D54 D06 S37291 Culm Valley V211005 260405 Stage 4.doc Version 1.30 Page 20 no 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 35 Regulation 17 Requirement You shall maintain records as specified in Schedule 4 regarding residents monies including receipts. You shall ensure that unneccessary risks to the health and safety of residents are identified and and so far as possible eliminated. (this refers to staff fire training). Timescale for action 26.07.05 2. 38 13 26.07.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 7 9 11 Good Practice Recommendations It is recommended that care plans contain adequate details to ensure that residents needs are fully met and reviewed. It is recommended that all medication is labelled with residents details and that returns are dealt with appropriately. It is recommended that residents wishes regarding spiritual needs are discussed, recorded and acted upon as appropriate. Culm Valley Care Centre D54 D06 S37291 Culm Valley V211005 260405 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Suite 1, Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Culm Valley Care Centre D54 D06 S37291 Culm Valley V211005 260405 Stage 4.doc Version 1.30 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!