Inspection on 10/02/06 for Cadogan Court

This inspection was carried out on 10th February 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

Cadogan Court 09/07/09

Cadogan Court 26/06/08

Cadogan Court 06/07/06

Cadogan Court 14/10/05

Cadogan Court 20/01/05

Cadogan Court 20/07/04

Cadogan Court 04/02/04

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 Cadogan Court Barley Lane Exeter Devon EX4 1TA Lead Inspector Ms Rachel Fleet Unannounced Inspection 10th February 2006 10.40 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 Cadogan Court DS0000026703.V274016.R01.S.doc Version 5.1 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. Cadogan Court DS0000026703.V274016.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Cadogan Court Address Barley Lane Exeter Devon EX4 1TA 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) 01392 251436 01392 410097 kfender@rmbi.org arichards@rmbi.org.uk Royal Masonic Benevolent Institution Katharine Josephine Fender Care Home 70 Category(ies) of Old age, not falling within any other category registration, with number (70), Physical disability (70), Physical disability of places over 65 years of age (70) Cadogan Court DS0000026703.V274016.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registered for up to 15 - OP with nursing Date of last inspection 14th October 2005 Brief Description of the Service: Cadogan Court opened in 1986, and now provides accommodation for a maximum of 70 people. It is registered to provide nursing care for up to 15 service users, and residential care for up to 70 service users, all of who should be over retirement age. The home is purpose-built, and stands in its own grounds on the outskirts of Exeter. There is some car parking space. The Home has its own transport for residents’ benefit. A local shop and public transport routes are available nearby. The Home has three levels, with lift access to all areas. There are various communal facilities around the home: several large lounges and smaller sitting rooms, a large dining room, kitchenettes, residents’ own laundry facilities, a library and a chapel. All bedrooms have en suite facilities. A requirement for prospective residents is that they have professional links with the Royal Masonic Institute. Cadogan Court DS0000026703.V274016.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector was at the home for seven hours on this unannounced inspection. She spent time with nine of the 62 residents around the home, besides seeing others briefly, speaking with a relative, five staff and Mrs Fender. She also looked at written records - including care plans, for casetracking purposes. CSCI comment cards were returned by eight residents and five relatives or visitors (including a community-based health professional). Standards that were met at the last inspection were not re-inspected on this visit. The report from that inspection, carried out on 14 October 2005, should therefore be read along with this report, for fuller information. What the service does well: What has improved since the last inspection? Social and recreational needs of frailer residents are met better. And outings are offered to each wing in turn now – more clearly giving everyone the opportunity to go out. Cadogan Court DS0000026703.V274016.R01.S.doc Version 5.1 Page 6 A loop system has been fitted recently in one lounge. Some windows on upper floors have been restricted to reduce the risk of falling from them. Aspects of medication management have been made safer. 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. Cadogan Court DS0000026703.V274016.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cadogan Court DS0000026703.V274016.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The home does not provide intermediate care. The other core standard was met at the last inspection. EVIDENCE: Cadogan Court DS0000026703.V274016.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 & 10 There is a possibility that some needs of residents may not be met because staff are not always fully informed about them. Safe management of medications is compromised by one issue. Personal support is generally offered in such a way as to promote and protect residents’ rights regarding privacy and respect. EVIDENCE: Some care plans had very good detail (including of multidisciplinary working) and informative evaluations. One had excellent evidence of mental health monitoring, wound care and inclusion of recreational needs. However, three didn’t include any social care needs. One plan didn’t include relevant blood glucose ranges for a resident with insulin-controlled diabetes. Care assistants said they were involved in care planning and said they found care plans useful sources of information. Documentation evidenced some residents or their representatives had been consulted about care plans. Residents had no complaints about how the home managed their medication for them, and said staff would answer questions about it if they asked. Although an issue regarding drug fridge temperatures was addressed at the Cadogan Court DS0000026703.V274016.R01.S.doc Version 5.1 Page 10 last inspection, another drug fridge – even though new - was not maintaining appropriate storage temperatures on this occasion. Staff had recorded some temperatures but not addressed the problem. A code used on administration chart needed better explanation. Systems for receipt and disposal of medication were well managed. Two staff, trained in medication administration, are now rostered for each shift on the residential wing, to ensure medication is given out on time – the medicine rounds taking a long time when only one person was available. Residents spoken with said staff were respectful, using their preferred name, knocking before entering, etc., and there were no concerns about privacy. Most comment cards from residents said privacy was respected; two said ‘Sometimes’. Visitors’ cards indicated they could visit in private if they wished to. Cadogan Court DS0000026703.V274016.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 & 15 The range of activities and opportunities on offer support and enrich most residents’ social lives as well as their religious and recreational interests. Residents are enabled to exercise choice and control over their lives. Meals provided are generally good, with choices available, and special dietary needs attended to. EVIDENCE: Residents spoken with had enough to do to fill their time. Comment cards indicated five residents felt suitable activities were provided (one saying, “Very good”), two thought ‘Sometimes’, and one said ‘No’. Residents and staff described various activities – from musical entertainments, Scrabble and cards to aromatherapy and animal visits. Church services for different denominations take place monthly. One staff said outings were offered to each wing in turn now. A loop system has been fitted recently in one lounge. Residents felt daily routines were sufficiently flexible and gave choice – meals, rising times, freedom to come and go around the home as they wished, etc. One resident whose ability to be independent had been lessening over recent weeks, said staff offered to assist them to the dining room, being prepared to walk with the resident or take them in a wheelchair, whichever the resident chose at the time. Staff on the nursing wing felt the routine was flexible Cadogan Court DS0000026703.V274016.R01.S.doc Version 5.1 Page 12 enough for residents to have a lie-in if they wished. A staff said issues relating to respectfulness and privacy were discussed at shift handovers. Residents spoken with said the food was good with regard to choice, time of meals, and having sufficient to eat. One who said it was usually excellent said it was occasionally cold. Two said snacks were available. Comment cards indicated six residents liked the food or found it reasonable, one noting the chef was good at catering for their special dietary needs; two said they liked it sometimes. A resident spoken with thought action had been taken by the home since they’d raised a particular concern about their diet. Mrs Fender said she’d look into two comments that coffee was cold, and served by some staff at the start of meals rather than at the end. Cadogan Court DS0000026703.V274016.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Appropriate action has been taken to try to ensure residents are protected from abuse. EVIDENCE: All eight comment cards from residents said they felt safe at the home, and all knew who to speak to if they were unhappy with their care. Detailed incident forms were seen. Staff files included signed agreements preventing staff from receiving gifts from residents or being involved with their wills. One staff was not certain who they might contact outside of the RMBI if they had concerns, although they had had attended training through the home on safeguarding. Other staff were well informed. One staff said the training on safeguarding included neglect as a form of abuse; they also knew the restraint policy had recently been updated. Cadogan Court DS0000026703.V274016.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The core standards were met at the last inspection. EVIDENCE: Cadogan Court DS0000026703.V274016.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 29 There is an appropriate skill mix of staff, who care about meeting residents’ needs. But there are not always sufficient numbers to ensure residents’ overall wellbeing. Protection of residents offered by the home’s recruitment policy is lessened by inconsistent standards of recruitment practice. EVIDENCE: All eight comment cards from residents said they felt ‘treated well’; when asked if they felt ‘well cared for’, seven said ‘Yes’ and one said ‘Sometimes’. One resident noted staff were equally kind to frailer, more dependent residents. Four visitors’ comment cards indicated they were satisfied with the care overall (one noting ‘10/10’); one was not. On the day of the inspection, 13 of the 62 residents needed nursing care, and were being looked after by 1 nurse with 3 care assistants. There were 7 care assistants looking after the 49 residential service users. The home also employs maintenance, catering, domestic and activities staff. Some residents spoken with felt there were generally enough staff, and they were capable. Others said they waited occasionally, one saying they might wait 20 minutes after ringing their bell and were concerned what would happen if they needed someone urgently. Two said, once staff came, they didn’t rush the resident and spent time with them. But they also felt there weren’t enough staff at mealtimes. Four of five comment cards from visitors (including a health professional) thought there were always sufficient staff on duty; one did not (particularly on the residential wings). Most staff felt staffing levels were Cadogan Court DS0000026703.V274016.R01.S.doc Version 5.1 Page 16 satisfactory for residents with nursing needs, and had improved on residential wings since recent discussions with management. One staff felt more staff were needed in view of having more dependent residents, especially at weekends. A new staff described how their application to work at the home had been dealt with, evidencing that the home had followed appropriate recruitment procedures. The files of three staff were seen. One staff had not had their ‘POVAfirst’ check or CRB (Criminal Records Bureau) check applied for before they commenced employment. Another had a gap in their employment history, but no record in the file that the home had looked into this. Inconsistent recruitment procedures were an issue raised at the last inspection. Cadogan Court DS0000026703.V274016.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 & 38 The home benefits from having a skilled manager. Generally there are good systems for promoting health and safety. However, one aspect should be addressed to ensure the welfare of people at the home. EVIDENCE: Mrs Fender is a registered nurse; she obtained the Registered Managers Award in January 2006. She has also had recent updating regarding first aid, safeguarding and manual handling. Residents felt the home was well managed and staff were organised well; one said wing meetings were useful and Mrs Fender acted to address matters raised. Some said although they didn’t see Mrs Fender often, they knew she would come and see them if they asked. A nurse felt they were well supported, and said Mrs Fender came to the nursing wing daily to ask how things were. Most care assistants felt senior staff were accessible – some felt they would go to senior carers, others felt able to approach Mrs Fender. Cadogan Court DS0000026703.V274016.R01.S.doc Version 5.1 Page 18 A risk assessment has been carried out of upper windows; some now have restricted opening as a result, but others still open fully. A notice was displayed informing all of planned work to fit radiator guards around the home. Staff said there had been a problem with the lift that had contributed to a resident’s fall. It emerged the lift had just been serviced prior to this incident, and the manager had asked the engineers to return to address the new problem. Fire safety checks had been recorded at recommended intervals. One staff spoken with was on the home’s Health and Safety committee. Some staff felt repairs were usually dealt with quickly, others felt this varied. A resident noted that whilst urgent matters were dealt with promptly, non-urgent repairs took much longer to be dealt with. Cadogan Court DS0000026703.V274016.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 2 28 X 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 2 Cadogan Court DS0000026703.V274016.R01.S.doc Version 5.1 Page 20 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 OP9 Regulation 13 (2) Requirement Timescale for action 16/03/06 2. OP29 19 & Sched.2 You must make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. All medicines must be stored within the appropriate temperature range. You must not employ a person to 16/03/06 work at the care home unless they are fit to work at the care home, which includes that there is full and satisfactory information available about them regarding matters specified in Schedule 2. 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 OP7 Good Practice Recommendations You should ensure a) That social care needs are included in all plans; and DS0000026703.V274016.R01.S.doc Version 5.1 Page 21 Cadogan Court 2. 3. OP27 OP38 b) That all care plans are sufficiently detailed to fully inform staff as to how they should meet identified needs. You should continue to monitor to ensure that there are always sufficient staff on duty to meet residents’ needs. You should ensure the health and safety of people at the home, including the provision and maintenance of window restrictors, based on assessment of vulnerability of and risks to service users. Cadogan Court DS0000026703.V274016.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cadogan Court DS0000026703.V274016.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!