Inspection on 01/08/06 for Cale Green Private Nursing Home

This inspection was carried out on 1st August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Cale Green Private Nursing Home 21/01/09

Cale Green Private Nursing Home 10/03/08

Cale Green Private Nursing Home 03/10/07

Cale Green Private Nursing Home 30/01/07

Cale Green Private Nursing Home 21/11/05

Cale Green Private Nursing Home 18/05/05

Cale Green Private Nursing Home 24/01/05

Cale Green Private Nursing Home 22/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Cale Green Private Nursing Home Adswood Lane West Stockport Cheshire SK3 8HZ Lead Inspector Kath Oldham Unannounced Inspection 08:45 1 August 2006 st 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 Cale Green Private Nursing Home DS0000017291.V292913.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. Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cale Green Private Nursing Home Address Adswood Lane West Stockport Cheshire SK3 8HZ 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) 0161 4771980 0161 4804928 woodeaves@smallwoodcarehomes.co.uk Smallwood Homes Ltd Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50), Physical disability (10), Physical disability of places over 65 years of age (50), Terminally ill (2) Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No service user may be received in the establishment who is less than 30 years old, male/female. 21st November 2005 Date of last inspection Brief Description of the Service: Cale Green nursing home is a care home that provides 24 hour nursing care and accommodation to 50 adult service users. Many of the service users accommodated at the home have high physical dependency needs. The home is privately owned by Smallwood Homes Ltd. Cale Green nursing home is situated in Cale Green on Adswood Lane West, about one and a half miles from the centre of Stockport. Local bus services are available. A small driveway leads to a car park and the main entrance to the home. The home is a two storey, purpose built building which has been extended to provide 43 single bedrooms and three shared rooms. Eleven rooms have ensuite toilet facilities. Assisted bathing facilities are available on both floors. There are lounges on both floors. The ground floor also has a separate dining area. Adaptations and aids are provided, including a passenger lift and hoists. The home has a statement of purpose and service user guide which were reported to be given to prospective service users or their families when they visit the home to look round. The fees for staying at the home were reported to be between £332.00 and £535.00 per week. Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection of Cale Green. The site visit took place on 1 August 2006 and 4 August 2006. Two inspectors undertook the site visit and gave feedback to the acting manager and general manager. The visit was used to monitor the requirements and recommendations of past inspections, examine records and to spend time in conversation with service users. Comment cards were given out to service users, relatives, visitors and staff. Comments received on the inspection and in comment cards are contained within this report. The case files of four service users were looked at in detail, looking at their experiences in the home from their time of admission to the present day. Breakfast was taken at the home with service users and lunch time meals were observed. A partial inspection of the premises was undertaken. The inspectors spoke with service users and several members of staff who were on duty. What the service does well: Service users commented that they received enough information about the home before they moved in so they could decide if it was the right place for them. Some service users indicated that they receive the medical support they needed. Service users and relatives commented that, in the main, the home was clean, bedding was always freshly laundered and service users wore clean clothes. One service user said that the house was not always as clean as they would like and more attention needs to be taken, for example, in cleaning the lift. The activities were reported by service users to be enjoyed although they stated more activities could be arranged for them. Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The administration, storage and recording of medication need to be improved to safeguard service users. Poor practice places service users at risk of not receiving the medication they require or having their medication administered wrongly to them. The care plans need development to reflect the actual care needs of service users. They need to be reviewed at least monthly or more frequently and these reviews must be recorded and include information that the service users and/or their relatives have been consulted. Two relatives told the inspectors that they wanted to make sure that the care needs of their cared for relative were provided as they should be and would like to see improvements in the communication systems in the home. The organisation and attention to correct procedures in the kitchen need to be addressed ensuring that practices are in line with environmental health regulations. The menus and record of food served need to be developed so a judgement can be made that service users are getting what they want to eat, a choice is being provided and the meals are nutritional in their content. Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 7 Staff need to receive supervision at least six times a year to further develop their skills. The routines in the home need to be reviewed and improved upon so service users are not waiting indefinitely for care, attention and meals. Staff need moving and handling training and need to be more vigilant when assisting service users to minimise the risk of cuts and abrasions. Staffing levels in the home need reviewing to ensure staff are deployed in sufficient numbers to meet the needs and requests of service users. The manner, approach and demeanour of staff need to be improved upon and the issues individual staff have addressed, ensuring that service users are treated with dignity and respect at all times. Care staff had not received any training in specific health and medical illnesses; this may help with providing care to service users who require an intermediate care service. Staff need to be familiar with what constitutes abuse and the process which must be followed if an allegation of abuse comes to light. Maintenance must be provided in a timely way to ensure that faults are rectified quickly and that refurbishment is continued throughout the home. The home needs to further empower and support service users to make comments on the service and its development. The home should demonstrate what action they have taken as a consequence of comments received. There are requirements outstanding from past inspections that are repeated and must be addressed fully by the home within the timescales set. 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. Cale Green Private Nursing Home DS0000017291.V292913.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 Cale Green Private Nursing Home DS0000017291.V292913.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): 1, 3 & 6 Quality in this outcome area is adequate. Information is provided to service users and they have their needs assessed prior to being accommodated. Service users admitted for intermediate care are supported to achieve the agreed outcomes of their stay. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Prospective service users are provided with an information pack, which contains both the home’s statement of purpose and service user guide. Whilst most information is detailed, information on the registered manager requires updating. Furthermore, staffing details need to be more specific as to number of staff, i.e., senior care assistants, care assistants, domestics, etc., and their qualifications. Fee structures should also be evident within the information. Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 10 Evaluation of a newly admitted service user’s file confirmed that the home receives pre-assessment information of prospective service users from the placing authority prior to their admission. The manager stated that should a placement be planned, she would visit the service user in their own home or current placement and assess their needs prior to being accommodated. Cale Green offers an intermediate care service (step up and step down). The home ensures it receives information about each new service user admitted into one of these short term support beds and reviews are held with a dedicated care manager to monitor the progress of each service user. Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. Care planning and medication practices did not identify or meet service users’ needs and staff failed to treat service users with respect. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Two service users’ care plans were seen and were, in the main, not correctly maintained. Service users’ weights were not recorded, wound care records were not up-to-date and could not confirm dressing care or improvement and/ or deterioration of the wound(s). Service users’ personal likes and dislikes regarding, food, activities, bathing and rising and retiring routines were not recorded. Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 12 Due to poor record keeping it was not evident how service users’ continued health care needs were met. One service user’s comment card indicated, “sometimes the staff are a bit rough when dressing and washing us and can hurt us quite badly”. A relative commented that the communication systems in the home were lacking. They stated that staff were not aware of service users’ individual care needs and that they were having to constantly remind staff of the agreed care needs of the service user. The relative has serious concerns regarding what happened to service users who didn’t have anyone to speak up for them. The impact of staff’s practice did affect service users, one service user commented, “sometimes there do not appear to be enough staff to help me when I need to move or use the toilet”. “Sometimes we are made to feel like a burden”. Medication administration records were poorly maintained, signature omissions were evident and inappropriate coding was used when medication administration differed from that prescribed. Staff were observed to handle medication during administration. There were no systems in place for monitoring stock or evaluating records and staff practices. There was no clear evidence medication was checked into the premises correctly and there was no record of medication leaving the premises either to the pharmacy or being discharged with service users. Service user details regarding allergies and photographs were not held with medication records. Due to poor management of medicines a cross-referencing of stock to medication records could not be completed. Such poor practice places service users at risk of not receiving the medication they require and/or having their medication administered wrongly to them. Service users were not treated in a consistent and respectful manner. Staff were observed to speak inappropriately about service users and left them for long periods of time in their wheelchairs. The home’s approach to ensuring that service users’ right to privacy were upheld culminated in some service users never leaving their rooms at all. Predominantly, those service users who it was alleged preferred to remain in their room were those who required a substantial amount of support. Call bells were not answered in a timely manner and personal care was not evident for some service users, even though odours of incontinence became noticeable. Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 13 One service user who had spilled their breakfast on the floor was left unattended in a lounge for some considerable time and a service user was observed to have toppled the table within their room and did not receive attention until the inspector summoned assistance. On at least two occasions service users were observed calling out for assistance for some time without being attended to until the inspector intervened and summoned assistance. Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 14 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, 14 & 15 Quality in this outcome area is poor. Most service users’ social and recreational needs are not met and meals are not appealing. Choice and control for service users was not apparent. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The home has recently employed a new activities co-ordinator who was previously a care assistant. A weekly activities programme has been developed and was displayed in the home. The co-ordinator stated that he had commenced including the details of any activity the service users have completed within their individual file. Service users were observed taking part in group exercises. One service user stated that the co-ordinator liked to take people out but that meant there was not a lot happening within the home. Service users had a meeting in July 2006 at which issues of increased activities were raised. Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 15 The inspector discussed with the co-ordinator about developing a programme, which enabled those less able service users to join in daily activities and/or receive individual social stimulation. Social profiles on service users may benefit the co-ordinator in knowing what service users would like to do as individuals. An entertainer was due to attend the home and preparations were underway for a garden and barbeque party. One service user commented, “there could be more activities, although those we do have are good”. One staff member indicated that if they could change one thing to improve the way the home works, they would “spend more money on residents, for example, minibus broken for over a year so residents can’t go anywhere.” Throughout the inspection it was evident that the majority of service users do not have control over their own lives. Routines appeared to be developed around care staff, who appeared to provide support when they wished and not as the service users required or preferred. Those requiring assistance in their rooms were observed to be waiting a long time for staff to respond to the call bell. On at least two occasions, inspectors had to place the call cords near service users to enable them to summon assistance. On another occasion, the inspector tested the response time to the call bell, which was in excess of eight minutes. One service user who needs support to turn and transfer from bed to a chair was spoken to by staff in an inappropriate manner. The inspector had summoned assistance due to his calls to be put back into his chair not being met. The care staff attending stated to the inspector, in the presence of the service user, “he’s only just been put into his bed, he’s always doing this”. “He’s confused”. At no time did the staff attempt to speak to the service user or find out what he wanted or explain why he may need to remain in his bed to relieve the pressure. The hairdressing room, and where service users were expected to wait, blocked walkways and restricted access to other parts of the home. One service user who was brought from the ground floor to the upper floor hairdressing service was observed to be waiting one hour and 40 minutes for the hairdresser to attend to her. The service user was left in the upper lounge without view of the television and other service users. Due to the long wait, one service user decided not to have her hair done and requested to go back downstairs. It was unclear how the service users who remained in their rooms had their hair done or if they were included within the hairdressing system. Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 16 Hot drinks were not provided when service users wished them; rather, they were provided within a rigid system. Service users were observed waiting for their morning drinks which were not served on the upper floor until past 11:30am. One service user said they were not aware when drinks were served and were thirsty. The manner in which they were served drinks was confusing, with numerous staff serving in a rushed and impersonal way. Some service users were served drinks out of child-style beakers, rather than age appropriate adapted drinking cups. No service users were offered second drinks. There is a four week menu in place which includes a variety of traditional type meals. A recent residents’ meeting highlighted the need to change the menu periodically to match the seasons. The menu had not been amended or varied to suit the warmer weather. Service users appeared to be waiting for long periods for their meals. Service users couldn’t remember what they had chosen for the meal, with one service user commenting that it is hard to remember what you had chosen two days earlier. One service user suggested having a menu on the table or on the wall to remind you what the meal is. One relative said the meals are usually served earlier than seen on the inspection but didn’t know why they were so late that day. Staff were not heard to apologise for the delay or offer any explanation why the lunch was being served so late. The appearance of the meal was not appetising with no colour to it. Staff were feeding some service users. The manner in which some staff undertook this task would not have promoted service users’ enjoyment of the meal. Service users were not routinely spoken to or asked if they had eaten enough or were not told what they were eating. Some staff interaction with service users was good, however this was not consistent. The preparation and storage of the teatime meal by the cook was not within food safety guidelines. A record of meals served at the home is not maintained, so it was not possible to make a judgement whether the diet is sufficient in terms of nutrition. Service users who were asked, did not know what the main meal of the day was. Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 17 Staff didn’t appear to interact with service users. A number of service users are not able to explain what they want due to their failing health and are dependent on staff to support them in day to day activity. Service users appeared to be placed where they were sat for the whole day with no change of scenery or alternative environment and minimum interaction. Some service users were heard to be persistently calling out, however when they were spoken with, their behaviour changed. Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be 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 poor. The recording of complaints is incomplete and not all staff are aware of the mechanisms for adult protection. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: A complaints procedure is in place and details the action that the home will take as a consequence of receiving complaints or comments about the service. A record of complaints is not currently maintained at the home in any semblance of order, so it is not practicable to see how the home has responded to complaints. A service user said they knew that the manager was usually available for them to speak to if they were not happy. The manager said that it was her intention to have a central complaints book to detail all complaints, the action to be taken and the outcome for the complainant. Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 19 The notes of a recent residents’ meeting identified at least two complaints, which should have been entered into the complaints record. Staff need to receive guidance and direction in what constitutes a complaint or comment and ensure that this is recorded in line with regulations and the action taken to remedy the complaint recorded. It was reported that about eight or ten staff have attended protection of adults training, as a means of training staff in what constitutes abuse. This provides some degree of protection to service users. Two staff indicated that they were not aware of adult protection procedures. As described throughout this report, the manner and attitude of staff is not satisfactory. Staff need to be more familiar with how their actions and behaviour affect service users and they need to receive direction, supervision and training in acceptable manners, routines and practice. Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23 & 26 Quality in this outcome area is adequate. The home was clean and without odours. Some redecoration is required and organisation of the communal areas is needed to promote service users’ comfort. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Bedrooms were clean, tidy and personalised. Some had been redecorated and were awaiting new carpets and curtains. One service user’s room was being redecorated. The service user stated she had not been asked about the colour but that the white and/or cream being used will be acceptable. Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 21 The lounges on the ground floor had very few chairs in them. One service user was sat alone in the lounge with no other chairs available to service users. The second lounge had more chairs, however the room didn’t give the impression of being homely or comfortable. Within this lounge was the dining room for the home. There were insufficient tables and chairs for more than 12 service users to have a meal at the table. The remainder of service users had their meals where they were sat on overlap trays. A relative indicated the house was always clean, their cared for service user’s bedding was always clean and pressed and there were never any odours in the house. A service user indicated, “Some areas of the home could be cleaner.” There were a lot of wheelchairs stored in bathrooms and, due to the number, they were also on the corridor. This compromises the safety of service users and staff and also makes the room unusable to service users. One service user said she had no hot water and the lights keep fusing. She also stated that there was “no point calling care staff (from her room) as the call bell does not work”. The inspector checked the room and found that there was no hot water and the bedside light was not working. The call bell worked when tested. Reference is made within this report that staff did not respond to call bells in a timely manner when tested on the inspection. A number of service users were observed to be out of reach of their call bells when in their bedrooms which means they are not able to alert staff if they need attention. Throughout the inspection it was observed that television reception was poor, culminating in poor quality picture on service users’ televisions. One service user commented that they “don’t know what I’m watching, its so fuzzy”. Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 22 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 Quality in this outcome area is poor. Staff were unable to meet service users’ needs through lack of numbers and skill. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: There were insufficient staff on duty on the inspection to meet the needs of service users. Two staff were not in work due to holidays or illness and had not been replaced. One of the nurses had a student with her, which added to the stress and workload of the individual. This had not been taken into account when deploying staff in the home. Staff were not organised or managed. One service user kept wandering from the lounge and was returned back by ancillary staff. She and many others were left unsupervised and without company for long periods of time. Staff were observed to be standing in groups talking, rather than attending to service users. Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 23 Two staff were observed hooking a frail service user under her arms when transferring her. As her legs gave way, she was observed to be ‘Hook lifted’ into a wheelchair. Another service user was transferred into a chair with only one footrest in place on her wheelchair. A further service user was transferred without footrests, with her bandaged legs dangling and the dressings trailing underneath the wheelchair. Another service user was heard to be told by staff to pick her feet up whilst being transferred in a wheelchair which was without footrests. Examination of three staff files identified that pre-employment checks had been undertaken prior to staff starting work as a safeguard for service users. The manager did not know what training had been attended by staff. A training matrix provided by the manager did not demonstrate that all staff had received the mandatory training. The general manager queried the information within the matrix, insisting that staff had received some training that was not listed. The manager stated that it was her intention to undertake a matrix and through supervision find out what training staff had taken part in. Fourteen staff were reported to have obtained NVQ level 2 qualifications. Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 24 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, 36 & 38 Quality in this outcome area is poor. The management of the home does not promote the health, safety and welfare of service users and service users’ money is not well managed. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: A manager has been appointed at the home since the last inspection and is attempting to become familiar with the systems and routines in the home and get to know service users and staff. The manager has a nursing qualification and has obtained the registered manager’s award. Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 25 Cale Green could not evidence through systems and/or practice that it was run for the benefit of service users. Staff appeared to dominate and decide how routines were to be completed and in what timescale. Comments were made by some staff in relation to “management” and the lack of working as a team; their feeling of resentment was evident. Quality monitoring had not been undertaken, although some auditing of aspects of the service had been undertaken. One relative and a service user said that he had missed the resident and relatives meetings that used to be provided. The money held on behalf of service users did not always match the amounts recorded as being held. A number of wheelchairs were observed being used with out footrests attached. Brakes were not always used and inappropriate support techniques were observed. Staff are not routinely provided with development supervision. This would assist in their individual development and inform the manager of the training needs of staff which, when provided, should improve the quality of care and support to service users. Kitchen-cleaning schedules were not evident and the temperatures of fridges and freezers were not recorded. The cook did not appear knowledgeable in safe food hygiene practices. The fire safety checks were recorded as having been checked at the required intervals. Fire drill practice or training was not recorded as having been undertaken by all staff. Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 26 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 2 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 2 X X 2 X X 3 STAFFING Standard No Score 27 1 28 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 1 X 1 Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 27 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 OP1 Regulation 4 &5 Requirement Timescale for action 31/10/06 2 OP7 3 OP8 4 OP9 The registered person must ensure that the home’s statement of purpose and service user guide are up to date and contain all the relevant information. 12, 14, 15 The registered person must 31/10/06 ensure that care plans are comprehensively recorded to reflect all the needs and preferences of the service user and that these are provided in practice. (Timescales of 28/02/05 and 28/02/06 not met). 12 The registered person must 30/11/06 implement systems which demonstrate how and when service users’ health care needs are met. 13 The registered person must 30/09/06 ensure that the management of medication promotes the safety of residents and complies with the Royal Pharmaceutical Society and the NMCs guidance. (Timescales of 30/06/05 and 15/12/05 not met). Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 28 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. 5 Standard OP10 Regulation 12 Requirement Timescale for action 31/10/06 6 OP14 7 OP14 8 OP15 9 OP15 10 OP16 The registered person must ensure that all residents are treated in a manner that respects them and promotes their dignity. (Timescales of the 28/02/05 and 15/12/05 not met). 12 The registered person must ensure that staff respond to the needs of service users in a timely and appropriate manner. 12,13 &23 The registered person must ensure hairdressing services are improved to provide safety and comfort to service users. 16 The registered person must review the food planning, serving and preparing of meals ensuring they meet service users’ choices and are prepared in line with food safety regulations. Sch 4 The registered person must maintain a record of food served, ensuring an assessment can be made that the individual service users are receiving sufficient diet in relation to nutrition. 22 The registered person must maintain a record of comments and complaints and detail within the record the action taken to remedy the complaint or problem. 31/08/06 30/09/06 30/09/06 30/09/06 30/09/06 Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 29 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. 11 Standard OP18 Regulation 13 Requirement The registered person must provide all staff with training in what constitutes abuse and assess staff practice to ensure that their actions could not be construed as abuse. The registered person must provide sufficient suitable seating in the lounge and the dining room for all service users accommodated. The registered person must ensure that staff are deployed and managed appropriately. The registered person must ensure that staff are appropriately trained and competent to support service users and that they ensure the safety of service users at all times when transferring and supporting them to move. The registered person must ensure that staff receive training and information about intermediate care. (Previous timescale of 28/02/06 not met). The registered person must make application for the registration of the manager. Timescale for action 31/10/06 12 OP20 16(2) 31/10/06 13 14 OP27 OP30 18 18 30/09/06 31/10/06 15 OP30 18 31/10/06 16 OP31 8 31/10/06 Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 30 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. 17 Standard OP33 Regulation 24 Requirement The registered person must ensure quality assurance and monitoring is undertaken regularly in the home. (Timescales of 01/06/05 and 28/02/06 not met). The registered person must ensure that residents’ personal monies are maintained safely and records of all transactions are accurate. (Previous timescale of 15/12/05 not met). The registered person must arrange for all nursing and care staff to receive supervision at least six times annually. The registered person must ensure that kitchen cleaning schedules, fridge and freezer temperatures and all other food safety matters are undertaken and that these are recorded in line with environmental health guidelines. The registered person must ensure that all staff attend fire drill practice and training at least twice a year and sign alongside their printed name on receipt. Timescale for action 31/10/06 18 OP35 17,20 31/10/06 19 OP36 18(2) 30/10/06 20 OP38 16(2) 30/09/06 21 OP38 23(4) 30/09/06 Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 31 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 OP12 Good Practice Recommendations The registered person should ensure that all service users are consulted regarding their preferred social activities and ways in which their individual social needs can be met. Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD 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 Cale Green Private Nursing Home DS0000017291.V292913.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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