Inspection on 09/08/07 for Culm Valley Care Centre

This inspection was carried out on 9th August 2007.

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 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 Dee McEvoy Unannounced Inspection 9th August 2007 09:00 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.V343638.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.V343638.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.V343638.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 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 26th October 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 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.V343638.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As part of this key inspection the manager completed an Annual Quality Assurance Assessment (AQAA), which contained general information about the home and the people living and working there. With the information provided, 13 CSCI surveys were sent to people living at the home, six were returned completed either by them or their families on their behalf. 15 staff surveys were given to staff during our visit and three were returned. Two inspectors visited the home without warning and spent just over 10 hours speaking with people living at the home, their relatives and staff. We also spent time observing the care and attention given to people by staff. At the time of our visit there were 40 people living at the home. In all we spoke with 22 residents of the home, four relatives and 15 members of staff, including nursing, care and domestic staff. Two relatives were also spoken with by telephone prior to the inspection. Before our visit we spoke with two health professionals to hear what they think about this service. Comments and views from all the people spoken with have been included in this report and helped us to make a judgement about the service provided. To help us understand the experiences of people living at this home, we looked closely at the care planned and delivered to six people. We spoke with staff about individual care needs, read plans of care records and made observations as to how care is delivered. We also looked at the accommodation provided to people and service areas such as the kitchen and laundry. We looked at health and safety records, staff recruitment and training records, and quality assurance information. Finally we discussed our findings with the person in charge at the end of the inspection. Two immediate requirements were issued during our visit, one in relation to the care delivered to one person and one relating to fire safety. The Commission received a satisfactory response from the home outlining the action they intend to take to address the immediate requirements. Since the last key inspection the Commission has received one complaint about poor staffing levels, which were having an impact on the delivery of care to people. The provider responded to this complaint. What the service does well: Good information is available to people to help them make a decision about whether the home will suit their needs and on the whole the admissions procedure at the home is good. People referred to the home through health or social services have a comprehensive assessment of their need completed by Culm Valley Care Centre DS0000037291.V343638.R01.S.doc Version 5.2 Page 6 someone who is suitable trained. Care planning and the monitoring of health needs was good ensuring that people’s health needs are met. Personal support is generally offered in such a way as to promote privacy. An activities person is employed to provide a range of individual and group activities enjoyed by many people. Organised activities include crafts, winemaking, planting, quizzes, manicures and poetry sessions. Visitors are welcome at the home and during our visit were seen to come and go freely. People are offered a balanced and varied diet and many told us that they enjoy the meals served at the home, their comments included, “ The food is always good”, “ I like nearly everything” and “ The food we get is fantastic”. People told us the food was generally of good quality with “plenty of it” available at mealtimes, although some said they would like a wider variety at times. The home offers people a pleasant environment – it is generally well decorated and bedrooms are homely and individualised. Most people told us that staff were kind and caring. Staff are keen to learn and want to provide a better standard of care to people. A good system is in place to ensure that people’s personal monies are administered correctly. People living at the home have been formally consulted about their experience of the care they receive. What has improved since the last inspection? What they could do better: Eight requirements and 13 recommendations have been made as a result of our inspection. The home must improve the delivery of care to people living at the home. Care staff must be aware of people’s individual needs and must be familiar with people’s care plans and instructions to meet individual needs. The home has been asked to improve the standard of personal care provided to people and ensure that all staff can assist people with fitting and maintaining their hearing aids. Aspects of the management of medicines must be addressed so that practices are safe and peoples’ wellbeing is ensured. Culm Valley Care Centre DS0000037291.V343638.R01.S.doc Version 5.2 Page 7 The activities at the home suit many people’s needs and expectations, but social and recreational opportunities for some people should be improved, to improve their overall quality of life. In order to fully protect people living at the home from the risk of harm or abuse, all staff must be aware of the adult protection procedures. To fully protect people, the home must consult with them, and their relative and other professionals when using restrictive devices to keep people safe. Several people we met told us they were not confident that their complaints or concerns would be addressed. The home has been asked to ensure that people are satisfied with the outcome of their complaints and that consistent improved is made where identified in complaints. The home must provide the equipment needed by people to aid their mobility and ensure they receive the care they need in a timely way. The practice of using hoist slings for several people should be review as it poses a risk of cross infection. Areas of the home smell of urine. Some new carpets are to be fitted shortly but in the meantime the home has been asked to reduce unpleasant smells. The number of staff on duty is not always sufficient to ensure that peoples’ needs and preferences are met in a timely way. Staff told us they only had time to provide ‘basic’ personal care and had little time to support people socially, psychologically or emotionally. Staff should receive relevant training to enable them to meet the complex and diverse needs of people living here. Staff should also receive a structured induction training to help them understand how the home works and how to care for people respectfully and safely. The home has been without a permanent manager since November 2005. Several staff and relatives expressed a wish to see a strong and effective manager in place. A permanent manager would ensure the home becomes more settled and continues to improve. The home must promote good fire safety by ensuring that all fire doors close properly and that door wedges are not used in any part of the home. Some staff require mandatory training such as manual handling and infection control to ensure good standards are maintained in these areas. It is recommended that the home improve the general serving and maintenance of equipment such as the sluice and kitchen dishwasher. 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.V343638.R01.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.V343638.R01.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): 1, 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides people with good information about the services offered to help decide if the home will suit their needs. On the whole the admissions procedure is satisfactory. EVIDENCE: There is a guide to the home, the Statement of Purpose, which is currently under review. This gives people an idea of what to expect of the home. Some people did not remember seeing it but these people have lived here a long time and some had memory problems. One person thought their relative might have seen the guide. Surveys from people living at the home showed that the majority had received enough information before deciding to move in. One person said they had come to visit before moving to the home and had decided that the home would suite their needs. Two relatives told us they had helped their relative when making a decision to move to the home. One person Culm Valley Care Centre DS0000037291.V343638.R01.S.doc Version 5.2 Page 10 we spoke with had recently moved to the home and said that everyone had made her very welcome, we were told, “I feel settled here”. During our visit a person came to visit the home to see if it were suitable for their relative. They arrived unexpected, were shown around the home and given a copy of the guide to the home to take away with them. Care files showed that information is gathered about individual health and personal care needs before people move into the home, including assessments carried out by health and social care professionals. These assessments contained some good information to help the home decide if they are able to care for people. A pre-admission assessment is also completed by a trained nurse at the home and where possible the person in charge will visit people before they move in to talk about their needs and the services offered. We looked at six assessments. Whilst these covered important areas of care, the recordings lacked depth and detail in places. The format for some assessments is pre-printed and just requires a tick or circle to identify where care or support is needed. For example, where assistance was needed with communication there was no indication of what the difficulty was or the appropriate assistance needed. If detailed assessments are not completed there is risk of someone being admitted to the home whose care needs cannot be met fully. Culm Valley offers a short stay rehabilitation service for people in the local community in partnership with the local GP practices and other health care professionals. At the time of our inspection no one at the home was receiving this care, so this standard was not assessed. Culm Valley Care Centre DS0000037291.V343638.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s needs are clearly set out in individual care plans but unless staff are aware of people’s needs and familiar with care plans people can not be assured that they will receive the care they require. Some areas of the management of medication are not satisfactory and could put people at risk. Personal care is generally offered in such a way as to promote privacy, but some practices do not uphold people’s dignity. EVIDENCE: People we spoke with were generally happy with the level of care they received, but some people felt that the delivery of their care was affected at times due to staff availability (Refer to standard 27). People responding with surveys felt that they “always” or “usually” received the care and support they needed. Although overall relatives praised staff at the home for their kindness and caring attitude, some concerns were raised about the lack of attention to Culm Valley Care Centre DS0000037291.V343638.R01.S.doc Version 5.2 Page 12 people’s personal care needs. Again this was raised in the context of staffing levels. We looked at six plans of care to help us understand how people’s needs were being met. Each person has a care plan, which informs staff about their needs and the action to be taken to meet those needs. These are well organised and well written. Care plans included information relating to people’s risk of poor nutrition and skin pressure damage, as well as risks to impaired mobility. Risks to peoples’ health, welfare and safety had been identified and actions to be taken to minimise risk are recorded. Records show that care plans are reviewed. Three relatives said they were invited to reviews of their relatives care. Some evaluations of care were detailed and reflected whether care or treatment was successful, others were not so complete and said things like “No change” over several entries. This made it difficult to assess how care was progressing. One health professional felt that the written care evaluations were often “unhelpful”. The care plan of one person was particularly good. It gave information about their medical condition and specific instructions on how to support this person to eat to prevent them choking. In addition appropriate referrals had been made to healthcare specialists. However, when spoken with three members of care staff said they do not read care plans and that they are not told what is in them. We watched one person being fed. None of the instructions relating to how to support this person to eat safely were followed. We asked two members of care staff if they had read the care plan and they had not, they were not aware of the complex conditions of some people living at the home. We showed them the instructions we had read in the care plan and they said they were unaware of these. The risk to this person was bought to the attention of the manager and an immediate requirement was issued to ensure that staff supporting this person had enough information to provide the required care safely. Two staff responding with surveys told us they were not told how to understand, work to and record in care plans. Staff surveys returned to CSCI also showed that staff are “ sometimes” given clear instructions about the job they are expected to do. One staff member felt that they were “never” given clear instructions or told about the particular needs of people living at the home. Surveys showed that two care staff felt they were asked to care for people outside their area of expertise. Two other care staff told us that they felt they needed more information about how to care individually for the people who live here. One said if they had better information, they could provide better care. The person in charge was keen to look at ways of ensuring all staff have an opportunity to read care plans regularly, which would improve the delivery of care. Culm Valley Care Centre DS0000037291.V343638.R01.S.doc Version 5.2 Page 13 Two relatives raised concerns with us about people not having their personal care needs attended to properly. For example, we were told that some men were not shaved regularly and that people’s dirty clothes were not changed unless staff are prompted. During our visit it was noticed that men were generally shaved but that some people’s hair was not combed and that several people had dirty hands or fingernails. Two people had food debris around their mouth following breakfast, but staff had little time to attend to them, as they were busy assisting other people with breakfast or helping them to get up. One lady had spilt a cup of tea down her front and care staff had to be alerted to this in order to assist her. Some care staff told us they only have time to do ‘the basics’ and that the morning was a particularly busy time (refer to standard 27). One relative raised concerns with us about staff’s ability to manage hearing aids. We were told that often hearing aids are not fitted properly, fitted but not switched on or not fitted at all. We were told, “This affects her whole world. It means she can’t join in with activities”. On the day of our visit this person’s hearing aid was not working until fixed by a visiting relative. The acting manager is aware of the problem and further staff training may be needed in this area. The majority of people told us they “always” receive the medical support they need. Records show that people receive support from relevant health care professionals including G.P, community mental team, specialist nurses, such as continence nurse and chiropodist, which ensure their heath needs are met. Two professionals told us they would like communication between themselves and the home to improve and felt they were not always informed of changes or incidents affecting people’s well being. Nutritional assessments were completed in files looked at and people’s weight was monitored. There was evidence that where people were loosing weight action had been taken to address this and the G.P had been consulted. Diabetic care plans were in place to guide staff and gave clear directions agreed with the GP about acceptable blood sugar levels and action to be taken should results fall outside of agreed levels. Nursing staff spoken with had a good understanding of people’s needs in relation to their diabetes. The management of people’s medication was looked at; No one living at the home was managing their own medication. The storage of medicines was generally good with the exception of medication requiring refrigeration. The fridge is old and appeared to be “hanging off” the wall. The fridge does not record maximum and minimum temperatures to ensure that medications are stored correctly and safely. It was noted that insulin in the fridge was not rotated according to date, for example staff were using insulin dispensed in June although there were two boxes dispensed in April and May that remained untouched. Culm Valley Care Centre DS0000037291.V343638.R01.S.doc Version 5.2 Page 14 Controlled medicines were stored securely and those checked tallied with records. During our visit we found that the home was not disposing of unwanted medicines correctly. Once brought to the attention of the person in charge and the local pharmacist, alternative and satisfactory arrangements were put in place. The Medication Administration Record (MAR) charts showed that variable doses are not accurately recorded with the actual dose given and no information was available to staff to guide them when using ‘as required’ medicines. MAR charts also showed two handwritten entries, which had not been signed by two people to verify the accuracy of the entry. Records showed that three people had not been given their medicine on a number of occasions, and codes were not used to indicate why medicines were not given. We looked at the supply of medicines for one person and found the doses were not in the monitored system and nurses felt that these had been given by not signed for. We saw that staff tried to maintain people’s privacy and dignity during the day, for example, people received personal care in private and staff were seen to knocked on bedroom and bathroom doors before entering. We heard staff addressing people in an appropriate way most of the time and people told us that staff were generally polite and kind. Two people said that staff could be rude and abrupt at times when busy, one lady said, “I think they are so busy they get fed up with us”. During the busy morning period one person requested to use the toilet several times but we heard staff say that he must wait, as they were busy with other people. This person told us that this often happens and can lead to incontinence, which this person found distressing and unnecessary. Staff told us “We do them after breakfast” – meaning they assist people at certain times rather than when requested. This gentleman waited for 45 minutes before being assisted to the toilet and was agitated and distressed by the time staff attended to him. Another person told us that staff had said she could use her pad if there was a delay in getting her to the toilet. This is not acceptable as this person was not incontinent but did struggle to “hang on” until staff could assist. This practice was seen to diminish people’s dignity. Culm Valley Care Centre DS0000037291.V343638.R01.S.doc Version 5.2 Page 15 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. There are good opportunities for social fulfilment for some people, but more specific recreational opportunities suited to peoples’ individual needs and capacities would support a better quality of life for all people living at the home. The meals offered generally provide choice and variety and meet nutritional needs. EVIDENCE: The home employs an activities person for 23 hours a week and she has developed a varied and entertaining programme for many people to enjoy. We were told that activities are planned to meet people’s interests and hobbies. Some care plans contained useful “life stories”, which gives a sense of what people are interested in. The activities person was aware of this information. Four volunteers also help with activities or sit and chat with people. We saw one volunteer taking someone for walk around the home, which was enjoyed. The activities person tries to provide activities indoors and outside in the lovely gardens, weather permitting. For example, people have enjoyed making wine, planting seeds and flowers, trying their hand at crafts and the weekly word Culm Valley Care Centre DS0000037291.V343638.R01.S.doc Version 5.2 Page 16 quiz also seemed popular. Hand and nail pampering sessions and the weekly hairdresser were popular with some people and other people told us they enjoyed the regular poetry readings. A trolley shop is available one day a week and people can buy small items and sweets etc. All residents of the home had a cream tea earlier in the week, with 18 people enjoying theirs out on the terrace in the sunshine. Some concerns were raised about the number of people attending activities (sometimes up to 18) and the lack of care staff support and supervision during these times. For example, one gentleman is prone to choking and the activities person was unaware of how to respond should such an episode happen when people were out on the terrace. When groups are as large as this and people have complex needs it would appropriate for care staff to assist. Trips and outings are organised on occasion. A monthly newsletter gives people up to date information for the month ahead about activities planned. August’s newsletter also had a newspaper article attached about a Maypole dancing event organised with a local school, which proved to be very successful. There are several people at the home who cannot or choose not to join in with group activities. Although the activities person tries to speak with everyone at the home monthly, it is unclear what social stimulation or meaningful activity they receive. One person told us they enjoyed the activities but didn’t always get down stairs in time to take part. A relative also felt that some people missed out on activities, as they weren’t assisted to attend in time. Surveys received from people living at the home show that 3 of the 5 responding could “always” participate with activities, others felt this was “usually or “sometimes” the case. Many people said that the activities co-ordinator is ‘brilliant’. Their faces light up when they talk about the things they do with her. However, they say that they get very bored when she is not there. Care staff are not generally involved in social activities. Staff told us they have little time to sit and chat with people, as they are so busy meeting their physical needs. When we asked three members of staff what they felt could be improved, they all said they would like to spend more time with the people. People’s spiritual needs are met by a monthly service at the home and records show that one person is assisted to attend her church of choice most weeks. Relatives were seen to come and go freely throughout the day and the people we spoke with told us that they are always made to feel welcome by staff. Two relatives felt that the home kept them informed of important issues concerning their relative. One relative described the staff as “Golden”, saying “They do their best to help my Mum”. Culm Valley Care Centre DS0000037291.V343638.R01.S.doc Version 5.2 Page 17 Care plans make some references about how to help people to make choices. Some people told us that they could get up and go to bed when they liked. Several care plans contain information relating to peoples’ favourite foods and what time they like to get up and go to bed. When spoken with staff were knowledgeable about these things. However, staff also said that they could not always make sure that preference times for getting up were met, because this depended on staff commitments and on having the right equipment available (refer to standard 22). One gentleman in bed at 10.30 said he would prefer to be up earlier but had to wait for staff to assist. During lunch we heard staff giving people choices about what to eat and how much they wanted. However, one person who does not have speech was not asked what they wanted to eat and was not told what they were being fed. Surveys returned to CSCI show that most people “usually” enjoy the food served at the home. People we spoke with said they liked the meals, comments included, “The food is good”, “I like nearly everything” and one gentleman told us, “It’s all beautiful”. Some people who have lived here a long time said food had become a little boring to them and one person was not happy with the quality of food or the variety offered. There is a four-week menu and a choice of two meals at lunchtime. The cook reports that she uses one fresh vegetable and two frozen vegetables for the hot meal. On the day of our visit the meals served were well presented and looked appetising. In the ground floor dining room, people were served individually and given a choice of vegetables. Food is served at the tables from heated trolleys to ensure it is hot. In the ground floor dining room the mealtime was unhurried and there was a pleasant atmosphere. People who may have spent the morning in their room appeared pleased to see each other and there was a buzz of conversation and laughter over meals. Staff were on hand to assist where necessary. Bowls of fruit are available in communal areas and hot and cold drinks were available during the day. Jugs of water or juice were seen in people’s rooms although one relative was concerned that fluids were not always freely available or fresh every day. We did see staff replenishing some drinks on the second floor during the day. People told us that on three days a week they can have a cooked breakfast and they really enjoy this. One person had been given porridge, but he said he did not like it without sugar. The member of staff who had given him this had gone on to provide care for someone else. People who need special equipment to help them eat independently had this available to them. Culm Valley Care Centre DS0000037291.V343638.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. People are not entirely confident that their complaints or concerns will be taken seriously. Unless staff are aware of the adult protection procedures people may not be fully protected from harm or abuse. EVIDENCE: The home has a complaints procedure and most people responding with CSCI surveys knew who to speak with should have any concerns. When asked, people said that if they had any grumbles they could just tell the staff and they would be sorted. Others said ‘it’s in one ear and out the other’ and ‘I’ve given up’. One person felt that their complaints were not taken seriously because there was not a strong leader. Two relatives told us that they had raised concerns in the past but felt things hadn’t improved, for example concerns about people’s personal care or the length of time it takes to answer call bells. We were told, “It’s like talking to a brick wall”. The Commission has received one complaint since the last inspection and this was dealt with by the home. The home’s records show that 12 complaints/concerns had been raised with the home in the past 12 months. The nature of people’s complaints has been recorded and the action taken to rectify or respond to the complainant is also recorded, as is the outcome. Although the home seems to have a good system in place some people we met were not entirely confident that complaints would be dealt with effectively. Culm Valley Care Centre DS0000037291.V343638.R01.S.doc Version 5.2 Page 19 People say they feel safe and that most staff are generally kind and considerate. Staff demonstrate a good understanding of what abuse is and say they would report any suspicions or disclosures to the manager. They were not sure who they would report issues to outside the home. One care staff member returning a survey to us said they were not aware of the agreed adult protection procedures, which could put people at risk. The person in charge said that POVA training was ongoing in-house and the home has a copy of the Alerters’ Guide and No Secrets training video. One person was held into their wheelchair using a lap belt. Staff say that if this is not in place that this person slides out onto the floor and is at risk of hurting themselves. The necessary written assessments and decision-making processes were not recorded. The manager agreed to follow this up. Culm Valley Care Centre DS0000037291.V343638.R01.S.doc Version 5.2 Page 20 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, 20, 21, 22, 25 & 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 within the home is generally satisfactory providing people with homely surroundings, however without the necessary equipment to help people mobilise individual needs may not be met. EVIDENCE: The home was originally a vicarage, which has been converted and extended over the years. The home has three floors, which are accessed by a lift, and it is set in lovely gardens with adequate parking spaces for visitors. There is plenty of communal space, including two lounge/dinning areas and other quite areas for people to enjoy. There is a large terrace with lots of tables, chairs and umbrellas outside for people to sit at. Some people were helped to sit out here by their visitors during the day. Culm Valley Care Centre DS0000037291.V343638.R01.S.doc Version 5.2 Page 21 The building is generally in good decorative order, and communal areas were bright and in the main pleasant. The home employs a full time maintenance person to deal with minor repairs and other jobs needed around the home. Bedrooms we visited had been personalised with pieces of furniture, pictures and mementos. People were generally happy with their accommodation. There are also large accessible bathrooms and toilets. Some people living at the home need a hoist or a stand aid to help them get in and out of bed or go to the toilet. One person reported that sometimes the battery for the stand aid is flat. This has resulted in them waiting to go to the toilet for 40 minutes and becoming ‘soaking wet’. When we checked, we found that on one floor there is one stand aid and one hoist. The Nurses report that up to nine people need a hoist to help them get in and out of bed and up to seven people need to use the stand aid. One person has their own hoist but staff say this has been broken for about 6 – 8 weeks. When we checked, some people were still in bed at 10.45am. Staff say that this is not necessarily a choice, people who need the hoist or stand aid have to wait until it is not being used by someone else. One health care professional also raised concerns about the lack of appropriate equipment at the home to meet people’s needs. Some of the equipment such as the hoists and wheelchairs were dirty. Some people are sharing the slings that are used on the hoists. This is a potential infection control hazard. When sitting in the lounge, some people do not have access to a call bell. When asked how they get attention, they say they call out or wait for a member of staff to come by. Domestic staff work hard to keep the home clean and fresh. Surveys received from people living at the home showed that the home was “usually” clean and fresh. The cleaners told us that they wash/shampoo the two lounge carpets on alternate weeks. Despite this, there are areas of the home that smell of urine and some of the carpets are stained. The person in charge told us that some of the carpets are being replaced this week. We visited the laundry, which was generally well organised and equipped. There are two washing machines (capable of washing at high temperatures) and two dryers. The laundress says this is adequate. In the laundry there were some sheets waiting to be washed on the floor, which is an infection control hazard. There was a large basket of ‘lost’ clothing items, which do not have name labels in them. One relative told us that several items of clothing belonging to their parent had gone missing, in spite of it being labelled. The laundress thought this could have happened when staff put the clothes away. The home has a number of sluices. Staff report that one of the two on one floor is not working. They do not know if it is to be fixed or not. Culm Valley Care Centre DS0000037291.V343638.R01.S.doc Version 5.2 Page 22 There are hand-washing facilities throughout the home to promote good standards of hygiene and staff were seen wearing protective clothing when necessary. Culm Valley Care Centre DS0000037291.V343638.R01.S.doc Version 5.2 Page 23 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 adequate. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff on duty are not always meeting the diverse needs of the people living at this home. Improvements in the home’s recruitment procedure ensure that people living at the home are protected and only suitable staff are employed. EVIDENCE: In general, people who live here were very complimentary about staff. They said staff were kind and helpful most of the time. Some staff were mentioned repeatedly as being particularly good. One person told us, “Staff do a splendid job and most are very nice and charming”. Relatives also praised staff for their caring attitude, one person told us, “The staff are very helpful”, and another said, “They are always lovely with Mum”. There are two floors at Culm Valley. Each is managed separately. There is a Registered Nurse (RN) on each floor all day and one RN at night. In the morning there are three care staff on each floor and in the afternoon and at night, there are two. On the day of this site visit the carers on one floor had started at 7.30am. They report that they can get everyone up at a time they like. People were washed, dressed and looked well cared for. On this day there were two carers on this floor who had their National Vocational Qualification (NVQ) in care. Culm Valley Care Centre DS0000037291.V343638.R01.S.doc Version 5.2 Page 24 On the other floor staff had started at 08.00am and said that they struggled to get people up in good time. None of the carers working on this floor held a National Vocational Qualification (NVQ) in care. Some people were still in bed at 11.00am. Care plans and discussions with staff did not indicate that this was a positive choice. People told us that staff are very busy and that sometimes they rush things. Several people told us they had to wait a considerable time for attention, sometimes up to 30 or 40 minutes. One person said, “You ring the bell but they don’t come”. One person said “If we had more staff they would have more time for us and we wouldn’t have to wait”, another person said they like their pillows in a certain way but that some staff were too busy to do this. Another person said they like to sit outside but staff were too busy to help them. People living here say that the call bells ring a lot. One person said ‘you get used to the call bells ringing all the time’. When we asked people living at the home what they would like to see improved they said more staff. All relatives contacted raised concerns about the staffing levels at the home, one wrote, “Due to shortage of staff, waiting a long time for someone to come often”, another told us, “Staff are rushed off their feet” and “I’ve seen people wait 30 or 40 minutes for assistance in the lounge”. Another relative said, “There are not enough staff to look after people properly”. One health professional also felt that staffing levels were “minimal” to meet people’s complex needs. Three staff returning surveys felt that care plans did not allow enough time for them to provide the care required. Staff told us they would like more time to be more particular with how they do things and spend more time with people chatting or doing things of interest. Several people mentioned the staff turnover to us; people felt there was no stability to the staff team at the moment, one person living at the home said, “There seems to be lots of different staff”. One relative told us; “Staff don’t seem to stay”, and member of staff felt that the staff team “needed stability to provide good care to people”. Some staff described low morale and thought that was why people were leaving. One staff member returning a CSCI survey said that the pay was poor and another wrote, “They don’t care about us”. Two staff told us they didn’t get enough support to do their job well. The recruitment files of 3 staff members were checked. Each contains an application form, written references and proof of identity, as is good practice to ensure that appropriate people are recruited to work in the home. We also looked to see that volunteers working in the home had undergone police checks and found this to be the case. Culm Valley Care Centre DS0000037291.V343638.R01.S.doc Version 5.2 Page 25 Although two of the three staff responding with surveys said they had received an induction period to help them understand how the home works and how to meet people’s needs safely, they felt they had not received enough support when they first starting working at the home and do not get the relevant training needed to understand and meet people’s needs. One person reported that they had not received induction training. Induction records of two staff were looked at; both appeared to have completed a structured induction but we couldn’t confirm that this was to Skills for Care standards. Records showed that both staff had been given a 3 month appraisal but where improvements had been identified, for example “to plan workload better”, there was no follow up to see if this had been achieved. Some care staff spoken with did not have an understanding of some people’s very complex conditions but said they would welcome extra training to help them provide better care. Trained nurses told us that they do receive relevant training, although this was mainly provided in-house. Although this was enjoyed and was considered valuable, nurses also said they would benefit from other outside training opportunities. This would provide nurses with a chance to meet other professionals and ensure that best practice was shared. Four nurses at the home are trained to take blood, which is a useful service. The person in charge is also responsible for staff training within the home and is currently undertaking an audit of staff training needs. Questionnaires have been sent to staff in order to develop a staff training programme. Currently just 14 of staff at the home have obtained NVQ 2 or above in care. This falls well below the 50 of staff expected to hold this nationally recognised qualification. Some staff say they would really like to their NVQ training but can’t because funding is not available. Culm Valley Care Centre DS0000037291.V343638.R01.S.doc Version 5.2 Page 26 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. Without consistent management arrangements the home has not made the necessary improvements to ensure that people living there receive good quality care and a safe service. EVIDENCE: The home has been without a registered manager since November 2005. A new manager was appointed a few months ago but resigned recently. Interim arrangements are in place but a clear message from staff was that they wanted a permanent strong leader at the home. Relatives were also concerned about management arrangements at the home, one person said, “We need a strong Matron”. One health professional felt the home lacked leadership. We spoke with the operations manager following the inspection and where told that recruitment was actively underway and an employment specialists were Culm Valley Care Centre DS0000037291.V343638.R01.S.doc Version 5.2 Page 27 helping them to find an appropriate candidate. The Commission will monitor the progress for the recruitment of a new manager. There are a number of ways that the home seeks people’s views, in order to review the services provided. Questionnaires are sent out and the results from these are collated. Results from a quality audit undertaken with questionnaires earlier this year show that people have mixed comments about the care provided, for example how care is provided, waiting times for assistance and how their complaints are responded to. The activities person speaks with people individually most months, any comments or concerns are recorded and passed on to the management for action. Minutes from these minutes show that people have discussed issues of concern on more than one occasion. For example, there was evidence that one person had raised their concerns about how their personal care was delivered over two consecutive months. Other people had also raised concerns about the time it took for their bell to be answered. We found similar concerns during our visit, which would indicate that people’s views or concerns are not always addressed fully and satisfactorily. The home has quite recently moved to an invoicing system for handling peoples’ monies. They currently hold small amounts of monies for two people. These were checked and found to be in order. All receipts are kept or spending recorded. There is limited access to these monies and these are kept safely. Staff surveys show that they did not receive regular supervision in order to assess their overall standard of work and identify training and development needs. Some staff felt they were not getting the support needed to do their job well. During our tour of the building we found some of the bedroom doors, which are fire doors, do not close properly. The kitchen door, which is a fire door, has a magnetic door holder but this is not working. This door is wedged open. The maintenance man carries out the weekly and monthly checks such as emergency lighting. The records had not been completed for two weeks as the maintenance man had been on holiday and no one had been delegated responsibility in his absence. These issues were bought to the attention of the person in charge and an immediate requirement was issued to ensure safety was maintained. Most staff spoken with said they had attended fire safety training, but records showed two or three required up-dates. The person in charge told us that records were not accurate and that all staff received regular fire safety training. We looked at the fire safety equipment, such as fire extinguishers and records showed that they had been suitable serviced and maintained. Some staff told us that they had received manual handling training but records show that two people are in need of up-dates. One person told us that some Culm Valley Care Centre DS0000037291.V343638.R01.S.doc Version 5.2 Page 28 staff could be a little “rough” when helping them to mobilise. This issue was also raised as concern with the home by another person. This was discussed with the person in charge and ‘gentle handling’ techniques are to be incorporated into the manual handling training for all staff in future. Staff working in the kitchen during our visit had received food hygiene training and other staff told us that they attended a health and safety course recently. Records show that some staff need infection control training. Not all training records were up to date making it difficult to assess where staff needed updates. In the kitchen records are kept of cleaning and any problems with equipment are noted and reported. It was noted that on some occasions, records would appear to indicate that the cleaning rota has not been followed. The Environmental Health Officer visited in May 2007. They recommended that meat be defrosted in the fridge. We saw meat being defrosted outside the fridge during this visit. They also noted there had been a history of problems with the dishwasher and suggested monitoring to ensure it was correctly maintained. The dishwasher was not working and had broken down a week before this site visit. Records show that gas and electrical systems are serviced and tested as required. PAT testing was carried out in March 2007 and the maintenance man checks weekly to ensure that window restrictors are working. Culm Valley Care Centre DS0000037291.V343638.R01.S.doc Version 5.2 Page 29 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 3 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 3 2 X X 3 2 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 2 X 1 Culm Valley Care Centre DS0000037291.V343638.R01.S.doc Version 5.2 Page 30 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 OP7 Regulation 12 (1) (a) Requirement Timescale for action 09/08/07 2. OP9 13(2) 3. OP18 13 (6) In order to deliver the care that people need, you must ensure that where there are specific instructions about how to feed a person to prevent them from choking, that these are known to and are followed by staff. An immediate requirement was issued during our visit. 21/09/07 In order to ensure that the management of medication is safe and people are protected, you must ensure that accurate records are kept of the medicines given to people and codes must be used where medicine is not given as prescribed. You must ensure that suitable arrangements are in place for the disposal of unwanted medicines. To ensure that people receive the appropriate dose of medicine prescribed with a variable dose the actual dose administered must be recorded. You must make arrangements, 05/10/07 by training staff to prevent people being harmed or suffering DS0000037291.V343638.R01.S.doc Version 5.2 Culm Valley Care Centre Page 31 4. OP22 23 (2) 5. OP27 18 (1a) 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. In order to protect people, you must consult with other professionals and gain consent when using restrictive lap-belts. You must ensure that the 30/10/07 appropriate equipment is available to assist people who have a physical disability, so that they receive the care they need in a timely way. Equipment must be regularly serviced and kept in good working order. In order to meet the diverse 05/09/07 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 unmet. In order to ensure that the home 29/11/07 is run effectively and efficiently, the registered provider must appoint an individual to manage the home Previous timescale of 26/01/07 not met. In order to ensure that fire 09/08/07 safety is maintained, you must ensure that all fire doors close correctly at all times and that they are regularly checked. Fire doors must not be wedged at any time. You must ensure that fire safety checks are undertaken as required. An immediate requirement was issued. In order to promote good 05/10/07 practice and protect people living DS0000037291.V343638.R01.S.doc Version 5.2 Page 32 6. OP31 8 (1) a 7. OP38 23 (4) 8. OP38 13 (5) Culm Valley Care Centre 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. 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 OP3 Good Practice Recommendations It is recommended 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. 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. The home should ensure that staff know how to fit and maintained people’s hearing aids. All staff should promote good communication with other health and social care professionals. It is recommended that maximum and minimum temperatures are kept to ensure that medicine store in the fridge is safe. It is recommended that people’s dignity is maintained by ensuring that staff assist people to use the toilet when needed. It is recommended that you ensure enough care staff support and supervision during large group activities. It is recommended that the home ensure that choice and autonomy is promoted for people who are unable to make the choices for themselves, and that people’s choices are met. It is recommended that people’s complaints and concerns are responded to and that they are satisfied with the action taken to address their concerns. It is recommended that individual slings be obtained for people requiring assistance to mobilise. All people living at the home should have access to the call DS0000037291.V343638.R01.S.doc Version 5.2 Page 33 2. OP8 3. 4. 5. 6. OP9 OP10 OP12 OP14 7. 8. OP16 OP22 Culm Valley Care Centre 9. 10. 11. OP26 OP28 OP30 12. 13. 14. OP33 OP36 OP38 bell in order to alert staff to their needs. It is recommended that the home is kept free from offensive odours and that sluicing equipment is serviced, repaired and kept in good working order. It is recommended that a minimum of 50 of care staff should be trained to NVQ Level 2 or above. 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 Huntington’s disease and dementia. It is recommended that improvements be made in response to the home’s quality assurance results. It is recommended that all staff receive supervision sessions at least 6 times a year. It is recommended that all staff attended infection control training to ensure that good standards are maintained. It is recommended that on-going servicing and maintenance of kitchen equipment is undertaken, such as the dishwasher. Culm Valley Care Centre DS0000037291.V343638.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton 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.V343638.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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