Inspection on 06/07/06 for Cadogan Court

This inspection was carried out on 6th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 10/02/06

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 Key Unannounced Inspection 6th July 2006 08.45 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.V295484.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. Cadogan Court DS0000026703.V295484.R01.S.doc Version 5.2 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 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.V295484.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registered for up to 15 - OP with nursing Date of last inspection 10th February 2006 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 does not offer intermediate care. A requirement for prospective residents is that they have professional links with the Royal Masonic Institute. 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. Weekly fees at the time of the inspection were £470 - £743. These did not include the cost of theatre outings/concerts (charged at 50 of the ticket price), magazines/newspapers (variable), toiletries (variable), hairdressing (£5), chiropody (£6) and aromatherapy (£2). Inspection reports produced by the Commission (CSCI) about the home are kept at the reception, in the home’s entrance hall. Prospective residents may read these, and are also directed to CSCI’s website. Cadogan Court DS0000026703.V295484.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. There were 63 residents at the home on the day of this unannounced inspection, eleven of who needed nursing care. A CSCI pre-inspection questionnaire had been returned by the home. Completed CSCI surveys or comment cards were also returned from eight residents (some completed with assistance, as suggested on the form), eight care staff and two communitybased health or social care professionals. The inspector met at least 18 residents around the home, speaking with eleven in some depth, as well as speaking with five staff (four of the care team – one of whom also worked in the laundry part-time - and the catering/operations manager) during the ten hours spent at the home. The inspection included ‘case-tracking’ of six residents - looking into their care in more detail by meeting with them, checking their care records and other documentation relating to them (medication sheets, etc.), talking with staff, and observation of care they received. Staff files, minutes of meetings, and records relating to health and safety were also seen. The inspector ended the visit by discussing her findings with Mrs Katharine Fender, the registered manager. Information gained from all these sources and from communication with the service since the last inspection is included in this report. The Commission has not received any complaints about the home since the last inspection. What the service does well: When asked this, one resident said, “ The caring nature of staff leaves nothing to be desired”; and of staff attention to frailer residents, they said, “They are generous in their care”. Other residents’ comments included, “The accommodation is very good, and the carers are also very good”, “I am very happy here – no complaints”, and “The outings”. One described the home as “Not casual at all – it’s well arranged”. Prospective residents’ needs are assessed well, helping ensure the home can meet the care needs of people who are admitted. Regular monitoring, with involvement of community-based professionals as necessary, helps ensure residents receive the health care they need. The home has good standards of hygiene, which protects their wellbeing. Cadogan Court DS0000026703.V295484.R01.S.doc Version 5.2 Page 6 Residents enjoy a well-kept, spacious and homely environment, with good access for wheelchair users. Their privacy is respected, and they are enabled to have choice and control of their lives where possible, promoting their dignity and rights. Regular and ‘ad hoc’ activities and arrangements provide opportunities for fulfilment. This includes continued contact with residents’ families, friends and the community around the home. Staff numbers and the skill mix are currently sufficient to meet residents’ needs, due to recent improvements. Training and support for staff ensures they have the knowledge and skills to safely provide necessary care. The manager has the knowledge and experience to ensure the home is run well, and run in the best interests of the residents. This includes having good systems that protect their financial affairs. Suggestions and complaints are received well, and used to improve the service that residents receive. Various policies and practices are used to try to protect residents from abuse or harm, including good recruitment procedures. Staff views about what the home does well included meals, cleanliness, social activities, promotion of independence, the overall care, equipment and training for assisting residents with moving, professionalism of the staff and good team work throughout the home. One staff said everyone was helpful, friendly and approachable, including management. What has improved since the last inspection? What they could do better: Two residents said there was nothing the home could do better. Another resident commented that the laundry system was unsatisfactory, with items going missing even though marked. Including good levels of detail in each care plan would help ensure residents consistently receive all the care they need. An unsafe aspect of medication storage must be addressed so that residents’ wellbeing is not at risk. Cadogan Court DS0000026703.V295484.R01.S.doc Version 5.2 Page 7 A wholesome, balanced diet is available but some individuals’ preferences are not being met. Good systems are in place to make certain health and safety matters are attended to. However, some additional action would further ensure the welfare of residents and staff. Suggestions on staff surveys about what the home ‘could do better’ included: having more staff so there was time to chat with residents, help them with writing, etc., and also on the evening and night shift - in the latter case, so that residents who liked an early bath or shower could be helped to have one; better handovers. 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.V295484.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 Cadogan Court DS0000026703.V295484.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (The home does not offer intermediate care). Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Good systems are in place to ensure prospective residents’ needs are fully assessed, promoting the success of any admission to the home. EVIDENCE: The manager meets prospective residents to assess their needs prior to admission, as two new residents confirmed. Pre-admission assessments were comprehensive and well detailed – including social interests, spiritual needs and information from current carers, for example. Assessments had also been obtained from Social Services or other professionals, where relevant. The manager also writes to confirm the home can meet prospective residents’ needs. All surveys from residents said they received enough information about the home before moving in so they could decide if it was right for them. Staff surveys said they had not been asked to care for people outside of their area of expertise, suggesting the home assesses people’s needs well and admits people appropriately. Cadogan Court DS0000026703.V295484.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 – 10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. There are adequate systems in place for informing staff about residents’ care needs, although lack of detail in some care plans may lead to inconsistencies in care and a risk that some residents may not receive all the care they need. Regular reassessment and multidisciplinary working ensures residents receive good health care. Management of medication is adequate, but one aspect must be addressed to avoid risk to residents’ welfare. There is good respect for residents’ privacy, with promotion of their dignity and rights. EVIDENCE: Each resident had a care plan, and some remembered being consulted when their care plan was first drawn up. Community professionals said staff demonstrated a clear understanding of residents’ needs, and followed the care Cadogan Court DS0000026703.V295484.R01.S.doc Version 5.2 Page 11 plans. These were person-centred, reflecting residents’ individuality. One informed staff well about how to care for a resident who was partially sighted. One included a resident’s personal fears and how staff should help them. One care plan, although it had no specific plan for social needs, covered this aspect of care in other parts of the plan - how physical disabilities affected the resident’s ability to enjoy certain activities, etc. Information from assessment tools was usually reflected in care plans. However, one mental health assessment did not provide staff with information on triggers for the problem or what they should do if the problem occurred; another did not reflect the risk of pressure damage identified by an assessment tool. Care plans had been reviewed regularly, sometimes with the resident’s involvement. Residents’ surveys said they usually or always got the medical support they needed. Residents seen looked well cared for. One resident, when asked if the home looked after their physical health, said they saw how other residents were looked after so had no doubt they would be too, if the need arose. GP and district nurses’ input was recorded. An optician visits the home regularly. When the inspector discussed that some residents had fallen more than once, one staff said they had had falls awareness training, to try to prevent falls occurring. A resident explained about adapted bathing facilities at the home, appreciating being able to use them. Another said they were weighed regularly; records seen showed most residents’ weights remained stable. Dietary likes/dislikes were noted. Various types of cups or beakers were provided, promoting residents’ independence and fluid intake. Staff were seen to follow appropriate procedures on medicine rounds; a resident said staff giving out medicines waited until they had taken their medication, to ensure they managed to take them. Residents asked said staff were very willing to answer queries about medications they brought to residents. A resident’s care record included their wishes about their medication regime. Much other good practice was evident – recording of variable doses when given, explanations of codes used on charts written on the chart’s reverse, two staff verifying stocks received and handwritten entries on medicine records, etc. However, some medication requiring refrigeration was not being stored at the right temperature, according to daily records; this can damage them, potentially reducing their effect, but staff had not identified this as an issue needing action despite previous requirements about this. Residents asked felt their privacy was respected. Community professionals said they could have privacy with residents. A staff assisting the inspector to find a resident politely indicated the inspector should wait outside their room while she explained the situation to the resident, then invited the inspector in once she knew the resident was happy to see the inspector. New residents are asked their preference regarding the gender of carers giving personal care, but also with discussion that it may not always be able to meet this preference. Staff surveys said they had been told not to talk about residents to anyone other than to senior colleagues. Toilet and bathroom doors have locks. Cadogan Court DS0000026703.V295484.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 – 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 fulfilment, to enrich residents’ lives. Good links are maintained with residents’ families, friends and the community around the home, helping to ensure residents benefit from supportive and interesting relationships. There is good promotion of residents’ choice, offering them control in their lives. The diet offered is adequate, with variety offered, but it does not entirely meet some individuals’ preferences. EVIDENCE: Five residents’ surveys said there was usually or always activities arranged by the home that they could take part in. One resident wrote they couldn’t participate because of their circumstances, and two said ‘sometimes’. One resident said they didn’t get bored, and were kept well informed about planned events by their peers; they had enjoyed some recent musical entertainments. Cadogan Court DS0000026703.V295484.R01.S.doc Version 5.2 Page 13 A monthly newsletter was also seen in bedrooms, and one resident said they could check notice boards for planned activities. They said they had not been asked by the home if the activities suited them, but said they would ask if there was something they wanted provided. The monthly activities diary showed six outings planned in June 2006 (although two were cancelled), as well as entertainments at the home. Three denominations hold services at the home each month. One resident said they felt wanted, and obviously enjoyed positive relationships with staff. A resident said their visitors were made welcome and could visit at any time; they also felt sure that staff would handle matters sensitively if a resident did not want to see visitors. Staff said there were weekly outings to local shops, the beach, etc., maintaining links with the community around the home. Fundraising for local charities was discussed at a recent residents’ meeting. Some residents attend local churches, remaining part of congregations they belonged to before admission to the home. Language in care plans reflected an enabling approach by staff – ‘offering’ aspects of care, rather than simply stating what was to be ‘done’ for or to residents. One resident was called by a nickname, noted on their records and which they said they were happy with. Staff were seen offering a choice of drinks and biscuits, rather than assuming they knew what residents would want. Care notes showed action had been taken that enabled someone to eat in company, as they wanted, but without having to rely on staff for assistance – thus protecting their self-esteem. One resident said they were able to bathe independently, having agreed with staff how to do this safely. Two residents described flexible routines around bedtimes. Notices around the home were in large print, giving easier access to information. All but one residents’ survey said they usually or always liked the meals at the home. Choices were offered; menus seen were balanced. Much was homecooked. The dining room was calm at lunch during the visit, with residents making their own way or being brought in at a pleasant pace; staff offered assistance in a friendly, polite manner. Residents spoken with knew they could ask for a snack in the evenings; one said they helped themselves, using the kitchenette on their wing. One resident said although food was of good quality, it was monotonous – there were a lot of ‘on toasts’, etc. One suggestion was for daintier options – thin bread and butter, or small cakes. Two residents indicated people only ate in their rooms if they were unwell, although Sunday tea is always served in residents’ rooms rather than the dining room. One felt the 6pm meal was of poor quality if taken in your room, and felt the choice of sandwiches was limited (which some staff also identified as an issue), but the other felt you were well looked after if you ate in your room. The catering manager noted these comments, and was happy to hear how he could improve menus; he said there was usually a good choice of sandwiches, so was going to look into this (serving arrangements, etc.). He visits new residents to discuss their preferences, as well as getting views from residents’ meetings. Cadogan Court DS0000026703.V295484.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good attitude to complaints, with residents enabled to voice their views, concerns or complaints. There are good safeguarding policies and practices in use, to try to protect residents from abuse. EVIDENCE: The complaints policy was displayed outside the dining room, as well as elsewhere at the home. A resident said, “You’re always free to say what you think,” and felt able to make a complaint if it were necessary. Another felt the home responded well to suggestions, raising of issues, etc. Residents’ surveys said they always or usually knew who to speak to if they weren’t happy; all but one said they always or usually knew how to make a complaint, the eighth saying it hadn’t been necessary yet. No complaints were raised during the visit. Residents who were asked said they felt safe at the home, and had not seen any untoward staff behaviour to frailer, more vulnerable, residents. Residents have safe storage facilities, though one didn’t feel the need to use it. Prospective residents are asked to appoint someone to take on Power of Attorney should the need arise once they are a resident, to ensure their financial affairs are handled appropriately. Residents’ surveys confirmed they Cadogan Court DS0000026703.V295484.R01.S.doc Version 5.2 Page 15 had received a contract, which also protects their rights. Of eight staff surveys, six said they were aware of adult protection procedures. Staff spoken with gave appropriate examples of what is considered abusive practice – including inappropriate attitudes to residents. They were aware of their responsibilities and the procedures for reporting any concerns. New staff sign an RMBI statement indicating they must not accept gifts from residents, or be involved with their wills. The manager has involved the police and other appropriate authorities when there have been concerns about possible abuse. Cadogan Court DS0000026703.V295484.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy a good, well-maintained, spacious and homely environment. Systems are in place to promote good standards of hygiene, protecting residents’ wellbeing. EVIDENCE: When one resident was asked if they were satisfied with the environment, they said there were call bells everywhere so if something were wrong, you could easily bring it to the staffs’ attention. None had any complaints about hot water supplies, their lighting, etc. and were happy with their accommodation. All areas are wheelchair-accessible, with automatic front doors, wide corridors and a variety of sizeable communal areas. Regular maintenance checks are recorded by the Head of Maintenance. Minutes of a recent residents’ meeting included discussing development of the garden. Some residents had enjoyed Cadogan Court DS0000026703.V295484.R01.S.doc Version 5.2 Page 17 being able to sit out there and chat, in the recent good weather - staff taking them out if they needed help. Staff spoken with had no concerns about the environment. The home looked clean, orderly and was generally free of unpleasant odours, with residents’ surveys confirming this was always or usually so. One room was odorous despite special attention; the manager said she’d look into this. Care records included monitoring of potential infection risks, and staff were seen to take precautions to minimise cross-infection during their work. A resident said they used the laundry room provided for residents. Staff in the main laundry described appropriate procedures and use of the washing machine programmes, to promote infection control. Cadogan Court DS0000026703.V295484.R01.S.doc Version 5.2 Page 18 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 - 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff numbers and the skill mix are currently good, having recently been improved to help ensure residents’ needs can be met. The staff as a team have good knowledge and skills to guide practice and ensure residents’ safety. Residents are protected by the home’s good recruitment policies and practices. Training and support for staff is good, helping them to provide the care residents need. EVIDENCE: Of eight residents’ surveys, most said staff were always or usually available when they needed them. A resident thought staff answered callbells as soon as they could, and felt staff were overworked. Another said staff didn’t have time to do things for them, but also said their keyworker was excellent in helping them with their hobbies, etc. Others felt staffing was adequate, and staff were helpful; one resident with poor sight said staff did not rush them, but were patient and explained what they were about to do. Of seven staff surveys, three indicated there was not enough time to provide the care indicated in care plans. Staff shortages due to sickness were mentioned by some staff, who also Cadogan Court DS0000026703.V295484.R01.S.doc Version 5.2 Page 19 said they could always do with more staff. One staff felt non-nursing residents’ needs have increased, causing some relative staffing shortages in that part of the home. Staffing levels have been increased very recently; however, this was coincidental - in response to an increase in resident numbers rather than in relation to residents’ needs. The risk of concerns about adequacy of staffing levels remains, therefore, which the manager is aware of. A resident and staff spoken with felt there was good communication between staff, one saying that better support and advice particularly between the nursing and residential wings has helped improve care. Housekeeping and catering staff teams support the care team. The pre-inspection questionnaire said nearly half of the care assistants have a recognised care qualification. A quarter are currently undertaking one, the external assessor visiting the home during the inspection; one staff spoken with was very enthusiastic about the opportunities to learn. There is always a nurse on duty, and a care assistant with a higher level of care qualification. The manager checks each nurse’s registration status yearly, with the regulatory body, to ensure they are still allowed to practice as a nurse. A resident said staff seemed skilled and knew their needs; another said the temperament of staff varied but the great majority really cared. Staff surveys showed appropriate recruitment procedures were followed. Staff files were well kept; information in four showed police checks, with other required information, is obtained before staff start working at the home. They also contained copies of terms and conditions of employment, given to staff. Exploration of gaps in employment records had not been recorded, although the manager was able to adequately explain those the inspector queried with her, having discussed them with the candidates; she said she will note this information on the currently-used interview form, which includes a variety of pertinent questions. Residents’ surveys said they usually or always received the care and support they needed. Staff surveys said all had had an induction, and induction records were seen in staff files. Two (one of whom was a night staff) said they had not had supervision, though they’d been at the home for over two years. The manager said part-time staff would be having a yearly supervision session at least, and that supervision was currently being ‘cascaded’ through the staffing structure. This identified training needs and objectives, as was reflected in one staff file seen and confirmed by staff. Staff felt the home provided plenty of relevant training. A record of recent training in one staff file included mental health issues and dementia. Notices about forthcoming training showed both mandatory topics and topics relating to older peoples’ needs. The preinspection questionnaire identified that a significant number of residents are visually impaired. There are specialist visitors to the home for some of these residents, but the staff training programme did not include this aspect of care. The manager agreed to try to address this. Cadogan Court DS0000026703.V295484.R01.S.doc Version 5.2 Page 20 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, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has good knowledge, skills and experience to ensure the home is run well. There are a good variety of strategies in place to ensure the home is run in the best interests of the residents. Good systems and practices used by the home protect residents’ financial affairs. There is adequate attention to health and safety matters, but additional measures would further protect residents and staff. Cadogan Court DS0000026703.V295484.R01.S.doc Version 5.2 Page 21 EVIDENCE: Mrs Fender has the Registered Managers Award, and is a Registered General Nurse. Residents spoken with were positive about the management of the home. One staff appreciated that Mrs Fender has worked ‘hands on’ shifts in the home. She has attended various health and safety updates, as well as a management course, in the last year. Staff surveys said their manager met with them regularly, and that they felt they had enough support from the home to do their job well. Meetings for day and night staff were being held soon. It was found that some suggestions on surveys for improving the home had been addressed by the time of the inspection - appointing a senior carer on night duty, and increasing staffing, for example. Yearly ‘quality of care’ surveys are sent out by the RMBI in the summer. Mrs Fender said she would follow this up, because none had reached the home yet. Wing-based residents’ meetings are held alternate months - recent discussions had included the food provided by the home. A resident felt the home worked in partnership with residents, with meetings used to inform residents about matters as well as giving the opportunity for them to talk about anything. One resident said they didn’t go to residents’ meetings often, because issues were usually dealt with when they arose, and they went to the office if they wanted ‘an answer about something’. Action had been taken to address issues found during a recent care plan audit by the manager. Personal monies records were computerised and well kept. Carbon-copies were seen, of receipts given to residents if they gave money into the office. Individual statements were produced at least monthly for residents or their representatives, with copies kept in the administration office, so they could review transactions on their account. Receipts were obtained for expenditure on residents’ behalf; those sampled matched entries on records. Occasionally only one person had signed for transactions, and the administrator said they would ensure two signatures were always obtained to verify the transaction. Staff spoken with had had updates, or were to attend them soon, on health and safety topics (safe handling of cleaning materials, food hygiene, etc.). A manufacturer was to give training about a new hoist. Residents had requested a fire safety talk, which was subsequently arranged. Records showed fire safety checks were carried out regularly; fire exits were clear. Some upper windows are unrestricted, with a risk of falling from them. Some had been restricted following risk assessment after a previous inspection. The manager said she would discuss it again with her seniors. Kitchen areas were well kept. A fridge display showed temperatures above recommended ones, although the unit felt cold; the catering manager intended contacting the manufacturers about this, but needed to have other means of checking the temperature Cadogan Court DS0000026703.V295484.R01.S.doc Version 5.2 Page 22 meanwhile, to ensure food safety. Senior staff were not aware of new regulations relating to catering, but will now be looking into this. Cadogan Court DS0000026703.V295484.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Cadogan Court DS0000026703.V295484.R01.S.doc Version 5.2 Page 24 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 handling, safekeeping & safe administration of medicines received into the care home. All medicines must be stored within the appropriate temperature range. Timescale of 16/03/06 not met. Timescale for action 31/08/06 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 that information from risk assessment tools is used to inform care planning, so there is sufficient detail to fully inform staff as to how they should meet identified needs. You should continue to try to ensure that all service users receive a wholesome appealing balanced diet. 2. OP15 Cadogan Court DS0000026703.V295484.R01.S.doc Version 5.2 Page 25 3. OP38 You should ensure the health and safety of people at the home, including a) the provision and maintenance of window restrictors, based on assessment of vulnerability of and risks to service users; b) ensuring food is stored at recommended temperatures; c) taking steps to ensure compliance with new food hygiene legislation effective from January 2006. Cadogan Court DS0000026703.V295484.R01.S.doc Version 5.2 Page 26 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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