Inspection on 14/10/05 for Cadogan Court

This inspection was carried out on 14th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 10/02/06

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 14th October 2005 10:45 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.V253444.R01.S.doc Version 5.0 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.V253444.R01.S.doc Version 5.0 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 Royal Masonic Benevolent Institution Katharine Josephine Fender Care Home with Nursing 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.V253444.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registered for up to 15 - OP with nursing Date of last inspection 20th January 2005 Brief Description of the Service: Cadogan Court opened in 1986. It is a purpose-built care home standing in its own grounds, on the outskirts of Exeter. There is limited 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. The Home is registered to provide nursing care for up to 15 service users, and residential care for up to 70 service users. A requirement for prospective residents is that they have professional links with the Royal Masonic Institute. Cadogan Court DS0000026703.V253444.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspectors Rachel Fleet and Sue Dewis were at the home for just over five hours. There were 58 residents accommodated there on the day. The inspectors spoke with thirteen residents, five care staff, the administrator and the manager. They also looked at documentation, including six care plans with associated documentation for case-tracking and the environment, before discussing their findings with the manager. A wing has recently been redeveloped and re-opened for residents needing nursing care. Whilst the refurbishment was underway, the role of senior care assistants has been developed through training and recruitment, to enable them to take charge of the care of residents not requiring nursing care, as Shift Leaders. This allows nursing staff to work solely with those needing nursing care, the number of nurses on duty being linked to the smaller number of residents formally assessed as needing nursing care. Nurses had previously been taking some responsibility for all residents, which took them away from those needing full nursing input. What the service does well: What has improved since the last inspection? Cadogan Court DS0000026703.V253444.R01.S.doc Version 5.0 Page 6 Some care plans had excellent amounts of detail, evidencing good nursing knowledge, and ensuring staff were well informed as to how to meet these individuals’ needs. 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.V253444.R01.S.doc Version 5.0 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.V253444.R01.S.doc Version 5.0 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): 3 Prospective residents’ needs are assessed and clearly identified, to ensure the home can meet their existing needs should they be admitted to the home. The home does not provide intermediate care. EVIDENCE: Care notes for a recently admitted resident had evidence of a full preadmission assessment of needs, made by senior staff from the home. Information from a previous health carer was also seen in other notes. One resident confirmed they had been visited by someone from the home before being admitted to the home, but their next-of-kin had otherwise dealt with the admission for them. The home has a standard package of information sent out to prospective residents, confirming they have been accepted for admission. Cadogan Court DS0000026703.V253444.R01.S.doc Version 5.0 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, 8 & 9 Residents’ health needs are well met, through good nursing practice, multidisciplinary working. However, staff are not always fully informed as to how to meet residents’ needs, because of a lack of detail in some care plans. Whilst medication systems are good, aspects of practice do not ensure residents’ welfare. EVIDENCE: Some care plans had excellent levels of detail, informing staff very well as to how they should meet those residents’ particular needs. For diabetic residents on the nursing wing, for example. However, care plans for those not on the nursing wing were less detailed. A care plan for a new resident did not include a social history, but the rest had at least some related information. Staff had reviewed care plans monthly, with some residents (or their representatives) involved in some of these reviews. Residents felt health needs were very well attended to. Some not requiring nursing care said it was less easy to consult a nurse now (under the new arrangements whereby Care Assistants are in charge of residential care), but added they weren’t neglected either. A chiropodist visited during the inspection. A shift leader confirmed they were well supported by district Cadogan Court DS0000026703.V253444.R01.S.doc Version 5.0 Page 10 nurses. This included receiving training for care of diabetics. Information from health risk assessment tools – relating to nutrition, for example - had been used to inform care planning, although the two documents had not been crossreferenced which would have alerted staff to other relevant information. Wound care is very well recorded (with wound measurements, etc.) and monitored. Residents were satisfied with arrangements for medications. One selfmedicating resident said they had safe storage facilities in their room. Another said they were recently assessed by staff as no longer being able to selfmedicate safely, and had agreed to let staff assist them. Staff in charge of care for residential clients confirmed they had had relevant medication training. Allergies were noted on medication sheets. Test results relating to Warfarin were faxed to the home by surgeries, to ensure clarity of subsequent action by staff. There was good written guidance for staff on medication procedures. Temperature readings for one drug fridge showed improper storage conditions, so immediate action was required to address this. Medication received into the home was recorded, but quantities given to self-medicating residents were not. A recommendation was made at the last inspection that these supplies be recorded. Records and systems for disposal of medication were very good, apart from where one signature not two had been recorded. Cadogan Court DS0000026703.V253444.R01.S.doc Version 5.0 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 & 13 Activities offered by the home do not meet social and recreational needs of frailer residents, although good community links and friendships within the home help to enrich residents’ lives. EVIDENCE: Some residents said there was enough for them to do with their time. However, a group said although activities were organised, they would like more entertainments provided, particularly for those who could not be ‘active’ - a talk, musical entertainment, etc. There was little evidence in care records of how recreational or social needs were being met, with an average of 1-2 entries per month. A member of staff felt it was usually the same few, more able, residents that went on outings. Information about the next church service at the home was displayed on notice-boards around the home. Visits by family or friends were noted in daily care records. Some residents have their own car still, and the home’s transport is used to take people out shopping, to places of interest, etc. One resident spoke about their friendships made within the home. A group of residents were enjoying a get-together before one of them returned home. Cadogan Court DS0000026703.V253444.R01.S.doc Version 5.0 Page 12 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): 16 Complaints are handled correctly and provide residents with confidence that their concerns will be listened to and acted upon. EVIDENCE: Residents who were asked were aware of how and to whom complaints should be made. They said they saw senior staff regularly, felt able to voice concerns to them, and thought issues were dealt with appropriately when raised. There is a complaints procedure available to residents on notice-boards and in the Service Users’ Guide. A complaints log is maintained and good details of complaints were recorded, with the outcomes of the complaint also shown. One resident who was visually impaired said they would like an audio version, which the manager said she would provide. Cadogan Court DS0000026703.V253444.R01.S.doc Version 5.0 Page 13 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): 19 & 26 The standard of the environment within this home is very good, providing residents with an attractive, safe, homely and clean place to live. EVIDENCE: Residents felt repairs were attended to in good time, the home was adequately maintained, and there were good standards of cleanliness. Standards of decoration, furnishings and cleanliness were very good on the day of this unannounced inspection. Garden areas were well kept, and there are areas that are easily accessible. Stocks of protective disposable gloves and aprons were seen around the home. Laundry staff are employed; those on duty were aware of concerns raised with the inspector by one resident about personal laundry, and were seen to have dealt with the matter already. The area was orderly, and machines had recommended programmes for disinfection of laundry. There are facilities elsewhere in the home for residents to do their washing themselves if they wish to. Laundry staff described appropriate procedures for dealing with contaminated items. Bedding (pillows, etc.) is regularly replaced with new stock. Cadogan Court DS0000026703.V253444.R01.S.doc Version 5.0 Page 14 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, 28, 29 & 30 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 practice in recruitment. EVIDENCE: One resident said their call bell was answered slowly and staff were rushed when they did come to assist them. Another said there weren’t many staff about, but spoke positively about them. Four residents said the staff were ‘excellent’, although a lot of agency staff were employed. They noted that residents had greater needs now, which affected staffs’ workload. And that because there were more attending health appointments, the home’s transport was used more often to take them, and thus it was less available for recreational outings, etc., besides taking staff away from the home as escorts. There is always a nurse, a Shift Leader and an NVQ3 level Care Assistant on duty, with 7-9 care assistants, during the day. At night, there is a nurse, an NVQ3 level Care Assistant and 4 care assistants. Care staff are supported by two activities staff, employed for 52 hours/week (including Saturday mornings); one drives the transport. Laundry, catering and domestic staff are also employed. Care staff said they were always busy, and that there was an audit currently taking place to assess the adequacy of staffing levels. Staffing levels on the nursing wing had been increased since it opened, in response to high dependency levels there. Cadogan Court DS0000026703.V253444.R01.S.doc Version 5.0 Page 15 The files of four new staff were seen. Two contained only one reference and did not have satisfactory CRB (Criminal Records Bureau) checks. The manager assured the inspector that neither staff would have unsupervised access to any resident, and that should the outstanding reference or CRB check be unsatisfactory, their employment would be terminated. The two other files had required information. CRB checks for staff appointed since the last inspection were verified, and should now be destroyed. Staff spoken with had an NVQ in Care, were undertaking one, or had previous relevant experience. They said there were plenty of training opportunities. A shift leader said they had had management training as well as on supervision and appraisal. They were hoping to undertake the Registered Managers Award, funded by the home. A new care assistant said they had had an appropriate induction period, with mandatory training included, and good support. The manager was trying to find a course on diabetes for staff. There was more mandatory (health and safety) training offered than for topics specific to residents’ needs, but staff were also developing care knowledge and skills through NVQ courses. Cadogan Court DS0000026703.V253444.R01.S.doc Version 5.0 Page 16 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): 33, 35 & 38 There are good systems for getting the views of residents or their representatives to help ensure the home is run in their best interests. The home is generally well managed, resulting in practices that promote and safeguard the health, safety and welfare of the residents (including their financial interests). Risk of falling from upper windows needs proper assessment, however. EVIDENCE: Residents spoke about residents’ meetings held on each wing by Mrs Fender, although some residents said several are too frail to participate in these. Results of a ‘quality of care’ survey given to residents and their relatives are still to be collated. The provider’s representative provides detailed monthly reports on the home, which evidence that issues for action are identified by senior staff, and progress monitored on subsequent visits. Cadogan Court DS0000026703.V253444.R01.S.doc Version 5.0 Page 17 Residents are encouraged on admission to make arrangements for an Enduring Power of Attorney. Residents’ personal monies, if handed to the home for safekeeping, are held in a separate account from the management of the home. They each have an individual account within the ‘RMBI Residents’ Fund Account’. The accounts are computer based and it is possible to see the individual balances for each resident. However, a maximum of £200 cash is kept at the home so it would not be possible for all residents to withdraw their cash at the same time. Mrs Fender (manager) has said that should this situation ever arise, it could be resolved relatively quickly. The accident Logbook was inspected and it was noted that one resident had had several falls. The manager was able to explain how the cause had been investigated and was being monitored. The Fire Log book showed that fire alarms were tested weekly and staff had appropriate training on a regular basis. ‘Dorguards’ have been fitted where residents prefer to keep their bedroom doors open, promoting safety in the event of a fire. Residents felt the environment was safe and generally well maintained. General risk assessments for the use of bedrails were seen, and those for the individual resident are maintained on their care plans. The manager confirmed that a lockable facility is being obtained for sharps storage. Two upper windows were found to have no restrictors in place, and could be fully opened (with a risk that someone could fall out). Cadogan Court DS0000026703.V253444.R01.S.doc Version 5.0 Page 18 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 2 Cadogan Court DS0000026703.V253444.R01.S.doc Version 5.0 Page 19 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 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. Timescale for action 14/11/05 2 OP29 19 & Sched.2 3 OP38 13(4) (Timescale of 28.02.05 not met, but issue has been addressed by new timescale given here) You must not employ a person to 30/11/05 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. 31/12/05 You must ensure that, as far as is reasonably practicable, parts of the home that service users access are free from hazards to their safety, and unnecessary risks are eliminated. This includes any risk of falling from unrestricted windows. Cadogan Court DS0000026703.V253444.R01.S.doc Version 5.0 Page 20 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 Refer to Standard OP7 OP9 Good Practice Recommendations You should ensure there is sufficient detail in all care plans to fully inform staff as to how they should meet identified needs. You should ensure quantities of medication given to selfmedicating residents are recorded. And records for disposal of medication should include signatures of two witnesses. You should ensure that the social and recreational needs of frailer residents are addressed. You should ensure that there are sufficient staff on duty to meet residents’ needs. 3 4 OP12 OP27 Cadogan Court DS0000026703.V253444.R01.S.doc Version 5.0 Page 21 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. 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