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Inspection on 10/03/08 for Cale Green Private Nursing Home

Also see our care home review for Cale Green Private Nursing Home for more information

This inspection was carried out on 10th March 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents 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. The internal and external appearance of the home provides a pleasant, comfortable environment for residents to live in and residents and relatives said the home was always very clean and tidy. Residents were positive about the food provided and said they had a choice at each mealtime. Visitors said they were always made welcome. Over 50% of care staff at the home have successfully completed NVQ training.

What has improved since the last inspection?

The manager has worked hard to make the improvements we asked her to make at the last inspection. We noted that she has done most of what we asked her to do, although we do feel that there is still room for improvements with the record keeping and monitoring of the care delivered to some residents. Redecoration and refurbishment of the environment are ongoing and some maintenance issues had been addressed since the last inspection, for example, the lighting in one of the lounges had been repaired. Two very large screen plasma televisions have been provided in the two lounges, so all residents can view programmes clearly. A loop system has been installed for residents wearing hearing aids. Since the last inspection the manager has started to spend more time working alongside the nursing and care staff. The morning routine seemed more organised and residents were served breakfast earlier than seen previously, although some residents were still left some time after that waiting for help with personal care needs. Improvements have been made in the assessment process which means that the manager can now be fully confident that only people whose needs can be met will be admitted to the home. A small sample of medicine records and stocks showed that medicines were being managed satisfactorily.Since the last inspection staff have undertaken training in care planning, moving and handling, wound care and continence care.

What the care home could do better:

Care plans were in place that generally corresponded with residents` assessed needs and although they had been reviewed along with risk assessments on a regular basis, we had some concerns that residents were still not being monitored effectively. Whilst care seemed to be adequate for residents who were fairly independent and whose health care needs were minimal, the poor quality of record keeping for residents with more complex needs put them at risk that their needs would not be met. Following the site visit, further information that we became aware of has led us to make a referral under Stockport Safeguarding procedures. The management of the home are cooperating fully with this process. Whilst staff had an awareness of the need to provide social stimulation for people, the arrangements tended to suit people who were more independent and further consideration should be given as to how the social care needs can be met for people who do not want to or are unable to join in with group activities. Staffing levels at the home are sufficient to meet residents` needs, however, we felt that the deployment of staff at mealtimes could be improved so that people have a better experience at lunch and tea time. The manager needs to continue to develop systems for checking and assessing the quality of care at the home to ensure that shortfalls are identified and addressed. Further specific training in topics such as diabetes, enteral feeding and care of gastrostomies, infection control and maintenance and use of pressure equipment is recommended to ensure that staff have the skills and knowledge to meet residents` needs.

CARE HOMES FOR OLDER PEOPLE Cale Green Private Nursing Home Adswood Lane West Stockport Cheshire SK3 8HZ Lead Inspector Mrs Fiona Bryan Unannounced Inspection 10th March 2008 08:15 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.V360281.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.V360281.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 477 1980 0161 480 0989 calegreen@smallwoodcarehomes.co.uk www.smallwoodcarehomes.co.uk Smallwood Homes Ltd Ellen Moorhouse 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) Cale Green Private Nursing Home DS0000017291.V360281.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. 3rd October 2007 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 current weekly fees range from £332 to £1,000 dependent on the package of care required. Further details regarding fees are available from the manager. Additional charges are also be made for hairdressing and other personal requirements. Additional charges may also be made for hairdressing, dry cleaning, personal telephone calls, private prescriptions, private care hire and taxis, special medical equipment and treatment. Cale Green Private Nursing Home DS0000017291.V360281.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key unannounced inspection, which included a site visit, took place on Monday 10th March 2008. Two inspectors visited the home. The home was not told beforehand of the inspection visit, we call this an unannounced inspection. This was the second key inspection for this service, as the first key inspection on 3rd and 12th October 2007 assessed the service as needing to make some significant improvements. Since that inspection, we have undertaken a random inspection on 19th December 2007, specifically to look at what improvements had been made in care records and the monitoring arrangements of people living at the home. At that time some improvements had been made. A short report about this inspection is available on request for any member of the public wishing to read it. Most of the key inspection standards were assessed at the site visit and information was taken from various sources, which included observing care practices and talking with people who live at the home, the manager, visitors and other members of the staff team. Key standards that were not assessed during this inspection were staff recruitment policies and the procedures for managing residents’ money as they were looked at during the last key inspection in October 2007 and were satisfactory at that time. Four people were looked at in detail, looking at their experience of the home from their admission to the present day. A selection of staff and care records was examined, including medication records, training records and staff duty rotas. Before the inspection, we asked for comment cards to be sent out to residents and relatives, asking what they thought about the care at the home. Four relatives and eight residents returned their comments cards. Comments from these questionnaires are included in the report. Since the last key inspection the manager has been registered with the CSCI and has produced an improvement plan to tell us how she was going to address the issues identified at the last inspection. We used this to check how the changes she had made had affected the quality of care given at the home. Cale Green Private Nursing Home DS0000017291.V360281.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The manager has worked hard to make the improvements we asked her to make at the last inspection. We noted that she has done most of what we asked her to do, although we do feel that there is still room for improvements with the record keeping and monitoring of the care delivered to some residents. Redecoration and refurbishment of the environment are ongoing and some maintenance issues had been addressed since the last inspection, for example, the lighting in one of the lounges had been repaired. Two very large screen plasma televisions have been provided in the two lounges, so all residents can view programmes clearly. A loop system has been installed for residents wearing hearing aids. Since the last inspection the manager has started to spend more time working alongside the nursing and care staff. The morning routine seemed more organised and residents were served breakfast earlier than seen previously, although some residents were still left some time after that waiting for help with personal care needs. Improvements have been made in the assessment process which means that the manager can now be fully confident that only people whose needs can be met will be admitted to the home. A small sample of medicine records and stocks showed that medicines were being managed satisfactorily. Cale Green Private Nursing Home DS0000017291.V360281.R01.S.doc Version 5.2 Page 7 Since the last inspection staff have undertaken training in care planning, moving and handling, wound care and continence care. 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. The summary of this inspection report can be made available in other formats on request. Cale Green Private Nursing Home DS0000017291.V360281.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.V360281.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Standard 6 does not apply. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People are provided with satisfactory information about the home and prospective residents have their needs assessed before admission. EVIDENCE: Potential residents and their relatives were given a copy of the Service User Guide, either when they visited the home or during their assessment visit. Feedback from discussion with residents who had moved into Cale Green indicated that they were given sufficient information about the home prior to moving in. Cale Green Private Nursing Home DS0000017291.V360281.R01.S.doc Version 5.2 Page 10 The assessment documents of five residents were looked at. The assessments were fairly detailed and gave a good indication of the residents’ needs. Some further information about residents’ abilities to do things for themselves would have been useful, for example, some assessments only stated that the resident needed help to maintain their hygiene but did not say if they could attend to any part of this themselves. The assessments looked at the physical, mental and social needs of the residents but corresponding care plans were not always available. This is discussed in more detail in the following section. One relative spoken to said that they and the resident they visited had been involved in the assessment process and they had received a contract on admission. Another relative of a resident who had been admitted from home told us that the manager had been out to the resident’s home to undertake an assessment of her needs. When the Local Authority funded people, care manager assessments were also in place. The manager said that since the last inspection prospective residents were always assessed, by herself or a senior staff member, prior to admission if at all possible. Cale Green Private Nursing Home DS0000017291.V360281.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Improvements in care planning mean that residents’ care needs are generally identified, but current systems fail to ensure that residents are monitored properly so potential health care problems may not be acted on promptly. EVIDENCE: Four residents were case tracked. Care plans, in the main, addressed most of the needs identified during the assessment process. Staff need to make sure that mental or emotional needs are addressed, as well as physical and personal care needs. One assessment stated that the person was depressed following the death of their spouse but this was not addressed as part of the care planning. Cale Green Private Nursing Home DS0000017291.V360281.R01.S.doc Version 5.2 Page 12 Also, one resident was admitted with a history of pain and was prescribed strong painkillers but there was no care plan to ensure that staff monitored the effect of the painkillers and reviewed his levels of pain. Residents with urinary catheters had care plans that dealt with bowel function but did not detail how staff would check that their catheter was working properly, how they would recognise any problems, such as infections, in the catheter and what action they would take if this happened. Care plans had been written for one resident who had been admitted 72 hours previously. Care plans contained details about the type of pressure relieving mattress required by a resident and those looked at during the site visit were set at the correct setting. Risk assessments were in place for all the residents for nutrition, pressure areas and moving and handling. Some residents had additional risk assessments because they needed bed rails or were transferred by hoist. The nutritional assessment for one resident showed that they had lost weight and had been referred to the dietician and the same resident had got a skin wound, which staff had referred to the tissue viability nurse and which was subsequently healed. None of the care plans and risk assessments showed evidence of involvement by the resident and they did not appear to be involved when care plans were reviewed. Poorly completed monitoring charts could still not provide enough evidence that care was always carried out as planned or monitored adequately. For example, one resident with a high risk of pressure ulcers did not, according to the charts, appear to have been assisted to move position for a period of nearly eight hours between 1:15pm and 9pm one day and the record showed further long gaps the following day. We also identified that the diet and fluid chart in place did not fully support the care which staff said they had given. Incomplete records mean that staff do not have all the information to accurately assess if the care given is meeting the residents’ needs. From information recorded on the charts, we had concerns that some residents were drinking insufficient fluids. One visitor said they were sometimes concerned that supplementary drinks had not been given to their relative, as there was sometimes nothing recorded. Cale Green Private Nursing Home DS0000017291.V360281.R01.S.doc Version 5.2 Page 13 Daily records for one resident frequently stated that their catheter was draining well but it was not clear how staff knew this, as it was only recorded on sporadic days that the resident’s catheter bag had been emptied. We also had concerns that staff were not proactive enough in ensuring residents’ health care needs were met. For example, the daily record for one resident stated on three separate occasions that a urine sample should be sent for testing. There was no evidence that this was ever done. On the day of the site visit we noted that urine in the resident’s catheter tubing had sediment in it and requested that a urine sample be sent that day. The nurse in charge confirmed she had done this. The day after the site visit the manager sent further information to say that a urine sample had been sent on 3rd March 2008 but no evidence was provided of this and staff on the day of the site visit were not aware of this, as it was not recorded anywhere. The manager said that they were only informed about the results of samples if treatment was required but staff should confirm definitely with the GP that a result has been received, to ensure the sample was tested and confirm no treatment is needed. The manager had recently investigated a complaint made by a relative, who had concerns about whether staff were proactive enough with regard to the resident’s health care. The manager had just developed a new form to help staff follow up health care issues. Residents, in the main, were positive about the treatment and care they received. One visitor said his relative liked the staff and said they were friendly and helpful and another visitor was pleased with the care his relative was receiving, saying, (it’s a) lovely atmosphere and staff kindness is evident in the manner in which they look after X. Other relatives said “The staff are wonderful nothing is too much trouble” and “they are usually ahead of the game in relation to my wife’s care” but one resident did say that staff sometimes shouted at him “as though you are demented” but thought this was because they forgot that not all residents were hard of hearing. Two relatives said they were kept informed about the welfare of the residents they visited. Examination of a number of residents’ medicine administration records indicated that medicines were generally stored, recorded and disposed of satisfactorily. It was noted that on the first floor the nurse finished the morning medicine round at approximately 11.15am and then started the next round at 1.15pm. Further observation about the daily routine is provided in the staffing section of this report. Cale Green Private Nursing Home DS0000017291.V360281.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Opportunities exist for people to engage in social activities and this is a developing area. More person-centred planning is needed to ensure that people’s diverse needs are met. EVIDENCE: A programme of activities and entertainment is arranged at the home on a regular basis and the programme is displayed on the notice board in the reception area and on the lounge door on the first floor. The programme demonstrated that entertainers regularly visit the home. Regular visits from local ministers and lay visitors ensure that residents’ wishes relating to their faith are supported. We were able to discuss the activities with the co-ordinator who was present during our visit to the home. The programme provides a guide to the activities on offer but can be adapted to meet the individuals’ wishes or changed if circumstances, such as the weather, make it difficult to carry out the planned activity. Cale Green Private Nursing Home DS0000017291.V360281.R01.S.doc Version 5.2 Page 15 The home has adopted a donkey and two residents spoke with great enthusiasm as they described the visit of a donkey to the home “we were able to stroke it and it loved the ginger biscuits”. Residents who are unable to partake in group activities receive one to one attention from the co-ordinator who spends time talking with them and keeping them company, but further consideration could be given to how people’s more diverse needs are met. For example, one resident said they were interested in current affairs and the news, etc., but found these things difficult to follow due to failing eyesight and a hearing impairment. A more person-centred approach to planning their social care needs may identify ways in which they could be helped to keep up to date with items of interest to them. Residents confirmed to us that they had the choice as to whether they attend activities arranged in the home. There is an ‘open door’ visitors policy and relatives and friends are encouraged to visit at all times. Several relatives were seen visiting the service during the inspection visit. One relative who returned a survey said, “The staff right down to the domestics are very helpful and always make you feel welcome”. A varied menu was available for the residents. All residents had a nutritional plan that recorded residents’ likes and dislikes relating to food. The cook said that this information along with feedback from residents’ meetings was taken into account when considering new menus. Most residents had breakfast in their rooms. Residents had a choice of a cooked breakfast or porridge, cereals, fruit and toast. Since the last inspection, the morning routine has been reviewed and most residents had been served breakfast by 9:30am on the day of the site visit. Choices were available for lunchtime and evening meals and the menu for the day was displayed in the dining room. A carer was observed in the morning asking residents what they wanted for lunch and tea that day. Lunch on the day of the site visit was meat and potato pie or cod in parsley sauce, mashed potato, peas and carrots. Dessert was bread and butter pudding or chocolate mousse. Appropriate meals were served for residents requiring soft food and diabetic diets. The meal was late being served but this was because it was the first day for the new chef who had just finished his induction training. Cale Green Private Nursing Home DS0000017291.V360281.R01.S.doc Version 5.2 Page 16 Part of a complaint that was received by the CSCI since the last key inspection and forwarded to the manager to investigate concerned the temperature of the food, which it was alleged was sometimes cold when it was served. A sample of the food served at the time of the visit was tasty and hot. The hot trolley used to transport and serve the food was in good working order. Residents in general said they liked the food, although one said that sometimes drinks were cold by the time they got them. On the ground floor only three residents sat in the large pleasantly furnished dining room. All other residents were either served in their rooms or remained where they sat in the lounge. Encouraging residents to move to the dining tables would provide pressure relief for less mobile residents and would create a more social occasion. On the first floor it was noted that about ten residents needed feeding. Although staff did come upstairs from the ground floor, the numbers of residents needing help meant that the mealtime went on until nearly 2pm. Two visitors were happy to assist their relatives but if they had not been there, this would have been additional pressure on the staff. It was noted that several staff were feeding residents whilst standing at the sides of their beds, which did not seem to be relaxing for residents. We were informed by the provider that owing to the height of the type of bed, staff were unable to sit down whilst assisting to feed residents. As stated in the previous section, we had some concerns that some residents were not getting enough to drink. We were unable to determine if this was the reality or whether staff had failed to record all the drinks that had been given. Although this issue arises within this section, as it refers to meals and drinks, as a lack of fluids could lead to dehydration and associated health care problems, we have also considered its implications as part of the health care section. Cale Green Private Nursing Home DS0000017291.V360281.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People who use the service are able to express their concerns and the arrangement in place provide protection for residents. EVIDENCE: A copy of the home’s complaints procedure was available in the reception area of the home and a copy was provided in each bedroom, within the service user guide. One visitor said he had been given a copy of the home’s complaints procedure when he had come to look round on behalf of his relative. A procedure was in place to record any complaints received by the home. The service had received one formal complaint since the previous inspection. Although the manager had responded, the complainant was still not completely satisfied and the CSCI has been informed that the social worker of the resident concerned would be making further enquiries. The manager has introduced some changes to address one of the issues that the complaint was about. All residents spoken to during the visits and who completed a survey form stated that they knew who speak to if they were not happy or if they wished to make a complaint. Visitors said that the manager was approachable and they were happy to discuss any concerns with her. Cale Green Private Nursing Home DS0000017291.V360281.R01.S.doc Version 5.2 Page 18 We suggested to the manager that a record should also be kept of minor concerns from residents and visitors, as this will help the manager to ensure that any frequent concerns can be recorded and subsequent remedial action be taken. Since the last key inspection, two safeguarding investigations are underway to which the provider and manager are fully co-operating. Records showed that most of the staff had received training in safeguarding. Staff spoken with said they had training in understanding what abuse was and what to do if they suspected abuse. Records were available of staff training. Staff also confirmed they had undertaken NVQ training and this also included information and training about abuse. Cale Green Private Nursing Home DS0000017291.V360281.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents benefit from having a homely, clean and pleasant environment in which to live. EVIDENCE: The home was clean and fresh and communal areas of the home were comfortably equipped with furnishings that met the needs of the residents. Since the last key inspection, large plasma screen televisions have been provided to enhance the residents’ enjoyment when watching films and programmes. The bedrooms were of a good size, nicely decorated, clean and well aired. Residents had their own personal toiletries, pictures, ornaments and mementos in their rooms. Cale Green Private Nursing Home DS0000017291.V360281.R01.S.doc Version 5.2 Page 20 A programme of routine ongoing maintenance was in operation and, since the last key inspection, the lighting in the main lounge on the ground floor had been repaired. The bathrooms and toilets were clean and were equipped with liquid soap and paper towels to minimise the spread of infection. One relative who returned a survey said that the hoist on the first floor had not been working for long periods of time. This was checked on the day of the site visit and was in good working order. Cale Green Private Nursing Home DS0000017291.V360281.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The staffing levels in place are sufficient to meet residents needs. EVIDENCE: There were mixed views from residents and relatives about the numbers of staff provided at the home. One person said, “they are always helpful and available to see to anything you need doing and nothing is too much bother”, but another said, “(the home is) going back to the way it was before. They were short staffed yesterday and I had to wait half an hour for the toilet by which time I had soiled myself. The buzzer was going constantly”. Although the staff duty rotas indicated that staffing levels were generally acceptable, many of the residents, especially on the first floor, appeared to be quite highly dependent. Observation of the morning routine on that floor showed that the nurse took until 11:15am to finish the medicine round and had to start the next one two hours later. Also, it was of some concern that at busy times of the day, such as mealtimes, the staff would not have been able to cope with the workload without the help of relatives that were visiting. Cale Green Private Nursing Home DS0000017291.V360281.R01.S.doc Version 5.2 Page 22 Consideration should be given to increasing staff levels at busy times of the day to ensure they are appropriate and in line with the dependency of the residents. Staff personnel files were not looked at during this site visit, as they were satisfactory when they were examined in October 2007. Records were available to indicate that staff received training from the start of employment with induction training to on-going training and NVQ. The induction training was in line with Skills for Care requirements. Since the last inspection, staff have received training in care planning, wound care, continence care and moving and handling. As stated at the previous inspection, further specific training in topics such as diabetes, enteral feeding and care of gastrostomies, infection control and maintenance and use of pressure equipment is recommended to ensure that staff have the kills and knowledge to meet residents’ needs. Staff were positive about working in the home and said that they enjoyed working there. Cale Green Private Nursing Home DS0000017291.V360281.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Systems for auditing the quality of the service provided at the home have started to identify and improve some care practices. EVIDENCE: Since the last key inspection the manager has been registered with the CSCI and has started to spend more time working alongside the nurses and carers so she can get a better overall view of how the service is being delivered and where there are issues that need to be addressed. Cale Green Private Nursing Home DS0000017291.V360281.R01.S.doc Version 5.2 Page 24 Staff, residents and relatives said the manager was approachable and accessible and most people felt that there had been improvements in the way the home was organised over the last few months. The manager said there had been lots of meetings, both formal and informal with all grades of staff to explain new systems of working and to ensure everyone was aware of their roles and responsibilities. Some of these meetings were minuted. Two resident meetings had also been held since the last key inspection and their views about the food obtained. These had been incorporated into new menus which had just been implemented. The manager has devised a matrix for nursing staff to ensure that all care plans and risk assessments are reviewed at least monthly and has given staff accountability for ensuring that this is done. The manager has developed the auditing system she had started at the last key inspection and checks that records are maintained in accordance with the home’s policies and procedures. Although care plans and risk assessments have improved and it was evident that a lot of work had taken place, systems need to be more robust to ensure that for those residents who need careful monitoring, this can be demonstrated and there is evidence of staff acting on the information they obtain as part of the monitoring in a timely and prompt manner. Procedures for the management and safekeeping of residents’ money were satisfactory at the last key inspection in October 2007 and were therefore not looked at during this site visit. The manager said an audit was undertaken by two members of staff every six to eight weeks of all money held at the home. Since the last inspection all staff have participated in fire drills and records were available to verify this. Records were provided to show that the hoists and Parker baths had been serviced on 10th January 2008. Cale Green Private Nursing Home DS0000017291.V360281.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 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 2 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X X 2 3 Cale Green Private Nursing Home DS0000017291.V360281.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Care plans must address all the residents’ personal, social and health care needs, so that staff have a framework to work from and know what care is needed and how it is to be monitored. The manager needs to make sure that staff are fully conversant with the care plans and the care to be delivered. (Timescale of 15/11/07 not met). The manager must ensure diet and fluids are provided to residents in accordance with health care guidance, residents’ personal requests and at reasonable intervals throughout the 24 hour day. (Timescale of 15/11/07 not met). Timescale for action 30/04/08 2 OP15 12 30/04/08 Cale Green Private Nursing Home DS0000017291.V360281.R01.S.doc Version 5.2 Page 27 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 manager should ensure that all service users are consulted regarding their preferred social activities and ways in which their individual and diverse social needs can be met. Staff should sit down when helping residents to eat a meal to ensure that residents feel relaxed and unrushed. The deployment of staff particularly around meal times needs to be looked at to make sure that residents receive their meals in a timely manner. Staff training should be arranged in topics such as diabetes, care of gastostomies, pressure area care and use of pressure equipment and infection control to ensure that staff have the skills and knowledge to deliver care to the residents. The manager should continue to develop and expand the systems she has put in place to check care practices and improve identified shortfalls. 2 3 4 OP15 OP27 OP30 5 OP33 Cale Green Private Nursing Home DS0000017291.V360281.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Manchester Local Office Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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