Inspection on 26/10/06 for Culm Valley Care Centre

This inspection was carried out on 26th October 2006.

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

Other inspections for this house

Culm Valley Care Centre 09/10/08

Culm Valley Care Centre 15/04/08

Culm Valley Care Centre 09/08/07

Culm Valley Care Centre 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 26th October 2006 10:00 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.V309727.R02.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.V309727.R02.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 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.V309727.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. Notice of Proposal to Grant Registration staffing/environmental conditions of registration issued 27/11/2001 Registered for up to 6 people Intermediate Care (50 years and above) The maximum number of placements including those of the named service users will remain at 56 This variation allows for the admission of one named person under the age of 65 in the category PD Physical disability. On the termination of the placement of 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 two named persons outside the categories of registration in the category DE [E] as detailed in the notices dated 26th January 2006 and 31st July 2006 1st June 2006 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 average cost of care is £354-630 per week at the time of inspection. Additional costs, not covered in the fees, include chiropody, hairdressing and personal items such as toiletries and newspapers. Previous inspection reports are available in the reception area. Culm Valley Care Centre DS0000037291.V309727.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Prior to the inspection, the home completed a pre-inspection questionnaire, which provides the Commission (CSCI) with current information about the service, staff and people living at the home. As part of the inspection, six people were case tracked; this means that the records linked to their care and stay were looked at and where possible they were spoken to. During the inspection a tour of the building took place and records including fire, care plans, staff recruitment, training, menus, and medication were looked at. Time was also spent observing care in the home and through spending time in the dining room. The inspection was unannounced and took place over 6 hours with two inspectors. There were 47 people living at the home. Time was spent talking individually to 13 people and their views on the care they receive have been incorporated into this report. As part of the inspection, discussion took place with the acting manager and with 9 staff, 8 of whom who were seen in private. These discussions are contained in this report, as is a summary of 2 surveys completed by anonymous staff members, 17 were sent out. Prior to the inspection, CSCI also sent surveys to 13 residents, and 3 responded, either independently or with the support of their family. Their anonymous responses have also been included in this report. 18 relatives’ surveys were sent out, 11 were returned. What the service does well: The quality of the activities offered in the Activity Programme are well organised and provide varied social opportunities for residents who are able to participate. Events include craft, wine-making, planting, quizzes, manicures and poetry sessions. Outdoor trips involving 17 residents include lunch out, tea at a hotel and a cream tea. The assessment and admission procedure is good. Residents’ health and personal care needs are well met although not always in a timely way. Meals are varied, well balanced and nicely presented offering choice and variety and staff offer sensitive assistance. All residents said that they were happy with the food. Assessments accurately reflect residents’ needs assuring that these can be met before they move into the Home. Culm Valley Care Centre DS0000037291.V309727.R02.S.doc Version 5.2 Page 6 Personal support is generally offered in such a way as to promote privacy and dignity. Contact with families and friends is flexible and generally promoted well within the Home. The Home has a good complaint procedure and the residents generally feel that they can raise any issue, which will be listened to and acted upon. Residents are well protected from abuse by informed staff and robust procedures. Ancillary staff are also alert as to risks of various types of abuse of vulnerable people and deal with this well. What has improved since the last inspection? Residents’ spiritual needs are well addressed by the Home who liaise with the local lay minister who visits regularly and these offered services are explained within the Home’s newsletter. The manager also said that they meet with the minister to discuss any residents who may have specific needs. Care plans have improved and now provide good, clear details about the residents, which should enable staff to know exactly how to meet their needs and are reviewed monthly. Although health and personal care needs are not met in a timely way they are met very well in conjunction with relevant health care professionals and by kind, caring staff. The administration of medication is well managed by a safe system. There are satisfactory Criminal Records Bureau disclosures received by the Home before a new staff member is able to work unsupervised. Mealtimes are now well managed with the introduction of a new system following a food audit by the Home. There is good and consistent maintenance of the premises at the Home and a full time maintenance man to ensure that residents live in comfortable surroundings. A quality audit has been carried out by the Home using quality assurance questionnaires and these results have been collated and the manager is acting on any comments to ensure that residents’ views are asked for regularly and acted upon. Culm Valley Care Centre DS0000037291.V309727.R02.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Culm Valley Care Centre DS0000037291.V309727.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Culm Valley Care Centre DS0000037291.V309727.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes assessment procedures are good, meaning that residents can be sure that staff will understand and be able to meet their needs if they move into the home. EVIDENCE: Assessments are completed before a resident moves into the home and these cover the relevant areas. The acting manager visits prospective residents before they come to the home. There are contracts for residents in their files. All bedrooms seen had a copy of the service user guide available, which means that residents can check what is available at the home. Two relatives said that they had visited the home before their relative moved in and had been ‘pleasantly surprised’. The admission sheet in the care files are detailed and use information gathered from relevant multidisciplinary health professionals to develop the care plan once the resident is admitted. The Home does not provide intermediate care. Culm Valley Care Centre DS0000037291.V309727.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of residents are well met with evidence of good multidisciplinary working taking place on a regular basis but not in a consistent and timely manner Personal support is generally offered in such a way as to promote privacy and dignity, but some practices need improvement The medication at this home is well managed promoting good health EVIDENCE: Six care plans were looked at. These contained all the necessary information to help staff understand the current needs of residents. The staff complete regular reviews of the residents , which means that care plans are updated when needed. On the day of the inspection two relatives explained that they were there for a care plan review of their relative who lives at the home. Staff Culm Valley Care Centre DS0000037291.V309727.R02.S.doc Version 5.2 Page 11 complete risk assessments, nutritional assessments, manual handling assessments and wound care instructions. One resident, who had recently returned from hospital, had a very good care plan describing their current needs. Staff were made aware of changes to residents’ health in the handovers held at lunchtime and there is a summary of health care needs to assist carers. One carer said that they had never been shown how to use the care plan and were asked to care for residents outside their expertise. Nurses said that they had worked very hard on improving the care plans. One plan had good details relating to a swallowing difficulty and all plans have a form for relatives to help fill in detailing residents’ social histories. Overall care plans were good and provide information to enable staff to meet residents’ needs. Although care plans were good and health care needs were well documented and met, residents’ needs were not seen to be met in a timely manner. (See details in Staffing section). The staff said that allocation of care each day was organised by a list, and that they were responsible for the ‘doubles’ or ‘singles’. References to the ‘feeds’ were also made during the course of the inspection, meaning those service users who may need assistance with their meals. There was also a list on the office wall stating which day service users were to have their weekly bath. Care is given in a task focused; rushed way and personal care tasks are not completed for some residents until 12.30. On the day of the inspection these residents were those who had limited communication and cognition skills. One resident said ‘ It’s beautiful. I have no complaints whatsoever, they do everything I need here, they’re wonderful’. A relative said ‘it’s very good here, they treat my relative properly, privately, she’s looking well and eating well’. One resident said that the Home was good years ago but not now. Two residents were resting in their rooms with gentle music playing and their call bells and drinks accessible and their glasses on. Any bed rails used had been risk assessed and discussed with the resident and/or representative. This means that use of restraint, such as bed rails, was being used appropriately and reviewed to safeguard residents’ rights. The medication system was inspected and part of a drug round observed. The controlled drugs were well managed and checked to ensure safe administration. All medication was in date including eye drops and fridge stored medication, which had opening dates recorded. Fridge temperature were checked daily. The Medication Administration Records (MARS) were all correct and any hand written prescriptions were checked and signed by two staff for safety. Staff were seen to sign that medicine had been administered only after they had witnessed the resident taking it which is good practice. Service users who were spoken to generally thought that staff treated them well, although thought they were rushed. Staff were seen to treat service Culm Valley Care Centre DS0000037291.V309727.R02.S.doc Version 5.2 Page 12 users with dignity, care and respect during the inspection; however a staff member was heard to be saying ‘ Good girl’ to one service user, and another service user was told to cover up their mouth at the dining table in front of other service users. One resident did not like it when staff would stand outside their room talking together and then would come in and say’ Alright ?’ and then walk out again. One resident’s door was left open all morning although the resident was sitting in their chair only wearing a pad and a pyjama top that was unbuttoned. Staff did not attend to this person to help them to get washed and dressed till 11.45am. One resident had a urine leg bag on full view in the lounge for some time but staff did then notice and cover it up. Culm Valley Care Centre DS0000037291.V309727.R02.S.doc Version 5.2 Page 13 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 good This judgement has been made using available evidence including a visit to this service. The home offers good creative and organised activities for some residents. Improvements could be made to ensure that all residents’ social needs are consistently met in relation to their abilities. Contact with families and friends is flexible and promoted well within the Home. Meals are nutritious and offer a balanced and varied diet. EVIDENCE: There is a good range of activities at the home provided by the activities organiser, which the service users said they enjoyed. They confirmed that the activity staff member provided sessions three times a week and ‘ She does all sorts of things’. The manager said that they meet regularly to discuss residents’ needs. These include word quizzes, seasonal events- such as a Halloween party, flower arranging, craft sessions, garden club, hand and nails pamper sessions, and a wine club. A monthly activities newsletter helps to Culm Valley Care Centre DS0000037291.V309727.R02.S.doc Version 5.2 Page 14 provide service users and visitors with up to date information for the month ahead. This month’s newsletter also had a newspaper article cutting, which was a report on a recent successful event in the home. There is also a hairdresser who visits weekly and a weekly trolley shop. Trips out are encouraged and in September there were three. Some residents went to a hotel for lunch, on a shopping trip and for a cream tea. 17 residents in total attended these trips. Photographs of trips are then displayed in the lounge. During the inspection 13 residents were enjoying a wordsearch quiz with the activities organiser and there was a lovely banter going on. The hairdresser had also visited. However, records did not indicate that all 47 residents were receiving regular social stimulation and engagement if they were unable to attend the activities on offer in the lounges. Carers have no input in providing activities although the manager said that carers do spend time with residents but they do not record this. This was not seen during the inspection as staff were busy. The activities organiser does monthly, sometimes two monthly, records for each resident and visits them all briefly. It is difficult to know whether some residents who have communication, cognition, and mobility problems or simply do not want to attend the activities that are offered are given any meaningful engagement throughout the week, or whether the newsletter is read to them to explain the activities on offer. Of the 3 resident survey responses all 3 said that they either could not attend or did not like the activities. Spiritual needs are met by a monthly Sunday service in the home, which the lay minister said was well attended. One service user confirmed that they were visited by a minister, and that this was of great comfort. The lay minister has input into the activities newsletter to explain their role and services offered such as a ‘good old chat’, company or prayer if they wish. Spiritual information is recorded in residents’ care plans. Religious events are also celebrated with singing from church visitors. The manager also said that they meet with the minister to discuss any residents who may have specific needs. There was evidence of staff having a good rapport with relatives visiting the Home. One staff member spent some time reassuring an anxious relative. Within the returned relative surveys 9 out of 11 said that they felt welcomed by the staff at the Home. Staff felt that meal times had improved since the last inspection. The evening cook now visits each service user in the afternoon and shows them the menu for the next day, and they choose what they would like. Residents at the table had all forgotten what the meal was and there was no menu displayed, which may help. The cook has a folder in the kitchen, which has a list of those service users at risk and their specialist diets and this has been regularly reviewed. There is also a list of the foods that service users prefer to eat, and foods that they don’t like. There is a choice of two meals available and also a cooked Culm Valley Care Centre DS0000037291.V309727.R02.S.doc Version 5.2 Page 15 breakfast three days a week. The cook also does a monthly survey, and visits all the service users to ask if they are happy with the meals. Lunchtimes are now at one o’clock. This has been changed to ensure that all residents have been assisted to get up in time. The qualified staff plate the lunches from a hot trolley and serve them and this has proved to be a success. Two staff were able to assist with feeding and were attentive to the 14 residents in one lounge asking them if they wanted seconds and checking their nutritional needs. Not all staff who deal with food have attended Food Hygiene training. Lunch was a calm and organised time and residents seemed to enjoy their meal. One carer was particularly skilled in encouraging residents to eat their meals. Residents were asked if they wanted gravy, and also given a choice of drinks. Salt and pepper were available on the tables, which were nicely presented. Culm Valley Care Centre DS0000037291.V309727.R02.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence including a visit to this service. The Home has a good complaints procedure and the residents generally feel that they can raise any issue, which will be listened to and acted upon. Residents are well protected from abuse by informed staff and robust procedures. EVIDENCE: All service users and relatives spoken to knew what to do and who to speak to if they had a complaint. One said ‘ if I had a worry I would see the Sister, but this doesn’t happen very often’. Another said ‘I know to go to the manager or one of the Sisters if there is a problem’. Relatives said ‘ we would see the manager or Sister. The manager has said we can go to him at any time’. However 5 residents felt that they could not speak to some staff due to language difficulties and 2 residents told how they had to wait longer for help because they preferred to be assisted by other staff of their choice. One resident had been told not be ‘so picky’. At lunch the manager came into the dining area and the 4 residents sat with the inspector said that he did not have any time to talk. However, they did not have any concerns other than elevenses being erratic and staff busy, which they did not want to report to the manager. Culm Valley Care Centre DS0000037291.V309727.R02.S.doc Version 5.2 Page 17 There is a complaints book and complaints were recorded although any other relevant documents relating to the complaint need to be kept together to monitor action and follow up. The administrator told the inspector how the Home have been aware of the risk of financial abuse in relation to their vulnerable client group and a recent incident had been sensitively and well managed using external resources to ensure that one resident’s best interests are preserved. Most staff had attended Protection of Vulnerable Adults (POVA) training and most staff spoken to knew what to do if they had to report an incident. POVA training is ongoing in-house and the Home has a copy of the Alerters’ Guide and No Secrets training video. Culm Valley Care Centre DS0000037291.V309727.R02.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment is satisfactory providing residents with safe and clean surroundings. EVIDENCE: The home was generally clean and tidy and odour free. Re-decoration continues at the Home and there have been new carpets with the first and second floor corridors being decorated. There is good and consistent maintenance of the premises at the Home and a full time maintenance man. There are domestic staff who carry out the cleaning in the home, but it was said that it can be a problem if there is sickness, holiday or the need for domestic staff to cover kitchen duties. There is a good infection control policy and uniform policy although some staff were seen to be wearing an excess of jewellery. Two staff were also seen to wear one pair of gloves between Culm Valley Care Centre DS0000037291.V309727.R02.S.doc Version 5.2 Page 19 different residents’ rooms although there was lots of gloves and alcohol gel available. Some staff were wearing excessive jewellery, which did not follow the Home’s own uniform policy and could put residents at risk of infection. There are two main lounges/dining areas on two floors and these contain a range of furnishings to meet the needs of service users. Bedrooms were homely and comfortable and service users had been able to bring in their own personal possessions. There is level access throughout the home and there is a passenger lift to all the floors. There are a number of hoists and manual handling equipment at the home and staff were seen to use these properly. One service user felt there could be one more stand aid hoist, as did some staff- but on the whole service users needs were met in this area. A staff member explained how the laundry system at the home worked. Infection control procedures were understood, but it was felt that some staff might benefit from a reminder as to using the correct temperature on the washing machines. The laundry is fully equipped with 3 industrial washing machines and 2 tumble dryers. Culm Valley Care Centre DS0000037291.V309727.R02.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. 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. Residents do not benefit from having sufficient numbers of skilled, experienced staff who can meet their needs in a timely way, although the service is delivered in a kind and caring manner. Improvements could be made in the procedures for the recruitment of staff to ensure they are robust and consistently protect residents. EVIDENCE: Some residents said that they thought that the staff were busy, but generally very kind. One resident said that staff were‘ mostly very busy on account of having to deal with so many people and so little time, but they try and come and spend as much time as they can’. Two relatives said ‘ staff are busy but we don’t have to wait too long if we ring the bell’ and all 11 of the relatives’ survey responses felt that there were not enough staff. Four care staff said that they were very busy, and thought that one more care assistant on duty would make a lot of difference. Currently there is one Registered Nurse and 3 carers on each floor with a ‘floater’ carer between the two floors. On the day of the inspection service users were being assisted to get up until 12.30pm, just before lunchtime. Culm Valley Care Centre DS0000037291.V309727.R02.S.doc Version 5.2 Page 21 The allocation of care each day was organised by a list, and staff said they were responsible for the ‘doubles’ or ‘singles’. Staff were keen to provide care in a more individualised and timely way but felt that they did not have time to do other than task orientated care. ‘ I love my job, the residents are what counts, its what I’m here for’ and ‘We really need 4 carers on each floor for the morning’, ‘ We need 4 carers so we can do the patients properly and take time. We feel pushed’ and ‘I wouldn’t like my mum to be rushed like this’. Staff also said that there wasn’t very much time to spend talking to service users, unless they were carrying out care. There is a named nurse system at the home, whereby each resident has a named qualified nurse responsible for their care. Not all residents seemed to be aware of this. Carers could be allocated different residents every day. All 8 staff spoken to said that it was usual for some residents not to be assisted up and out of bed until 12.30 and at least 6 residents were still in bed at this time during the inspection. Residents spoken to said that they would prefer to be up much earlier. One resident had been alone shouting out (which this resident does) all morning and was only seen by a carer to wash them at 12.30. Another resident was calling out for help in the upstairs lounge for 20 minutes until they were assisted. Three residents were sat in their wheelchairs at an empty dining table at 10.30 until lunchtime. There is an elevenses drinks round at 11.00 but one kitchen staff member does this and also stops to assist with feeding so the round can take a long time. Residents spoken to said that often they did not get a hot drink or that it was close to lunchtime. The manager agreed that this was a problem and they would be looking at this. Residents said that they did feel that their care needs were well met at the home by kind and caring staff. All 11 relatives who returned surveys said that there were not enough staff at the Home although they were satisfied overall and that staff were very kind. Staff and residents spoke about difficulties sometimes with staff who were from overseas. Some staff felt that there were communication problems, which led to the residents not always understanding the staff- this was also repeated by three residents and 5 relatives. Two residents preferred to wait longer for staff who had better language skills to be free to assist them. These staff were seen to be very caring and considerate with the residents although some staff did have limited language skills. At least two staff supervision records noted this difficulty and pointed out that they needed assistance, encouragement and direction when working including working with senior staff on duty. This means that although there may be 3 carers on each floor and one ‘floater’ some of the staff may be working with another staff member. Two staff confirmed that this normally happened and these staff did have to work with them, which slowed down delivery of care in the mornings. The manager was not aware of the overall dependency levels of current residents (i.e. how many staff they need to assist them) and said that they would look into this information to take into account when doing the staff rota. Culm Valley Care Centre DS0000037291.V309727.R02.S.doc Version 5.2 Page 22 Six staff personnel files were looked at. All contained the correct Criminal Records Bureau (CRB) documentation. All staff also are checked on the POVA list prior to employment and the manager said that staff are supervised until their CRB disclosure is received. One file did not have any follow up into why a staff member had previously been dismissed from a home, another had no employment history since 2003 and another had no six-week appraisal following employment. This staff member said that they had had little support since working at the Home and did not know if they were doing well or not even though they were expected to supervise other carers. The Home has copies of the General Social Care Code of Conduct booklet for staff. There is a ‘policy of the month’ which staff `are encouraged to read and the manager then goes round asking them related questions. Unfortunately less than half of the staff had signed to say they had read them. There are individual staff training records and staff have attended a variety of relevant training, which means that they should have the knowledge to meet residents’ needs. However there is not a clear formalised induction programme based on Skills for Care, which includes follow up appraisal sessions following employment such as at 6 weeks and 6 months to ensure that all staff are competent. Culm Valley Care Centre DS0000037291.V309727.R02.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ financial interests are safeguarded. There have been improvements in some aspects of the running of the Home but further improvements in management will ensure that residents’ needs are met consistently and safely. EVIDENCE: The Home has been without a Registered Manager since November 2005. The Commission wrote to the provider asking for an update on the situation and a copy of the advertisments placed. The provider has written to the Commission saying that they are actively recruiting and included evidence of advertisements. There has been an acting manager working at the Home Culm Valley Care Centre DS0000037291.V309727.R02.S.doc Version 5.2 Page 24 since early 2005 but they have decided not to apply for the post. There have been improvements at the Home during this time although this needs to continue to ensure that failings detailed in this report are addressed and acted upon. The registered nurses said that they felt well supported and the Home continues to undergo a period of change as part of the improvement plan to re-structure the organisation in the Home. Some staff said that they felt more supported by management and that there had been regular staff meetings including carers. Staff supervision sessions have commenced slowly, several staff spoken to have not yet had individual supervision. 4 supervision summaries relating to staff with specific needs were sent to the inspector following the visit, but this does not detail the dates, content or specific action required where necessary. The Home have employed a Registered Nurse in a supervisory role to oversee care on the ‘floor’ and staff said that although this had been threatening to start with it was proving very useful and supportive, for example in improving care plans with staff. The Home has recently sent out quality assurance questionnaires and collated these sending a summary to CSCI. The manager said that they are acting on any comments. A representative of the company conducts monthly visits to check on the quality of care provided. Mealtimes for example have improved due to findings from a recent audit. There are regular relatives’ meetings run by the activities organiser. Three residents’ monies were looked at. There is a good invoicing system and residents keep little cash at the Home. Any cash is stored in separate pouches with clear itemised records. All three inspected were correct. The administrator said that residents do not go without if they should need to buy something and their funds have temporarily run out. Currently no residents deal with their own money by choice. Health and safety is generally well managed at the home. Fire and other equipment are regularly checked. The Environmental officer visited in April and the manager said that requirements were being dealt with. There is a current electrical wiring certificate. Substances that might be a risk to residents are well stored and risk assessed. There are insufficient training records of manual handling, which means that both staff and resident’s safety may be at risk. However the staff on duty were using the hoists and manual handling equipment properly. The ground floor toilet wash basin had very hot water and needs a warning sign. Culm Valley Care Centre DS0000037291.V309727.R02.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 2 X 3 Culm Valley Care Centre DS0000037291.V309727.R02.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP27 Regulation 18 (1a) Requirement Timescale for action 26/12/06 2. OP29 19 Schedule 2 3. OP31 8 ( 1) a You shall ensure that at all times there are suitably qualified, competent and experienced persons working at the Home in such numbers as are appropriate for the health and welfare of residents. (This refers specifically to care staff in the mornings to enable residents to be have their personal care needs met in a timely manner) This requirement is carried over from the previous two inspections. Timescale 13/12/05 and 1/07/06 unmet. You must obtain for all persons 26/12/06 working at the Home appropriate documentation prior to employment as in Schedule 2. This refers to a more robust recruitment procedure. See textbox. The registered provider shall 26/01/07 appoint an individual to manage the home Culm Valley Care Centre DS0000037291.V309727.R02.S.doc Version 5.2 Page 27 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 OP8 OP10 OP12 Good Practice Recommendations It is recommended that health and personal care is delivered in a more individualised way focussing on person-centred care. It is recommended that staff are aware of the need to be more vigilant in maintaining residents’ privacy and dignity. (see textbox for details- Health and Personal Care). It is recommended that staff ensure that the social and leisure needs of all residents are met, including those with limited capacity and those who do not attend those activities offered in the lounge. It is recommended that all staff who deal with food have attended Food Hygiene training. It is recommended that as some staff have less English language skills than others that the residents which they care for are offered the opportunity to access and express any complaints or concerns to staff that they feel they can talk to more easily. It is recommended that the Home’s uniform policy is adhered to by staff as some staff are wearing an excessive amount of jewellery, which could be an infection risk and that carers do not wear one pair of gloves between rooms. It is recommended that all staff who use the laundry are aware of the correct procedures, which relate to infection control policies such as the correct temperatures. It is recommended that the staff rota is devised in conjunction with a clear overall picture of residents’ dependency levels to ensure that their needs can be met by the staff on the rota. It is recommended that there is a clear, structured induction and appraisal system, which meets Skills for Care requirements. It is recommended that all staff receive supervision sessions at least 6 times a year. It is recommended that all records and training related to Manual Handling are up to date. 4. 5. OP15 OP16 6. OP26 7. 8. OP26 OP27 9. 10. 11 OP30 OP36 OP38 Culm Valley Care Centre DS0000037291.V309727.R02.S.doc Version 5.2 Page 28 12. OP38 It is recommended that if there are any areas where the taps emit excessively hot water, these are risk assessed and action taken as necessary such as warning signs. Culm Valley Care Centre DS0000037291.V309727.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Ashburton Office Linhay Business Park Ashburton Devon TQ13 7UP 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. Extracts may not be used or reproduced without the express permission of CSCI Culm Valley Care Centre DS0000037291.V309727.R02.S.doc Version 5.2 Page 30 - 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. 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