Inspection on 03/10/07 for Cale Green Private Nursing Home

This inspection was carried out on 3rd October 2007.

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

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

Other inspections for this house

Cale Green Private Nursing Home 21/01/09

Cale Green Private Nursing Home 10/03/08

Cale Green Private Nursing Home 30/01/07

Cale Green Private Nursing Home 01/08/06

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 Mrs Fiona Bryan Unannounced Inspection 3rd & 12th October 2007 08:30 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.V351874.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.V351874.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 ** Post Vacant *** 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.V351874.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. 30th January 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 home offers a ‘step up’ service for six people. This means people living in the community who require emergency short-term care and support, but not medical treatment, can go into the home to receive this. The home also has two beds for respite care (short-stay breaks). 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 may 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 taxi, special medical equipment and treatment. Cale Green Private Nursing Home DS0000017291.V351874.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection, which included a site visit, took place over two days on Wednesday, 3rd October and Friday 12th October 2007. The manager of the home was not told beforehand of the inspection visit. All 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, visitors, the manager and other members of the staff team. We sent the manager a form before the inspection for her to complete and tell us what she thought they did well, and what they need to improve on. We considered the responses and information the manager provided and have referred to this in the report. Four people were looked at in detail, looking at their experience of the home from their admission to the present day. A tour of the building was conducted and a selection of staff and care records was examined, including employment and training records, staff duty rotas and residents’ care plans. A pharmacy inspector assessed the arrangements the home had in place for dealing with medicines. An expert by experience assisted the inspector for part of the inspection. The phrase “expert by experience” is used to describe people whose knowledge about social care services comes directly from using social care services. This person talked to various residents about their quality of life. She also spoke with some visitors. She completed a report after the inspection; some of her written comments are included in this report. Since the last inspection a new manager has been appointed who has started the process to register with the CSCI. What the service does well: The internal and external appearance of the home provides a clean, pleasant, comfortable environment for residents to live in. Residents liked their rooms and several said the standard of cleaning was good. Cale Green Private Nursing Home DS0000017291.V351874.R01.S.doc Version 5.2 Page 6 The proper employment checks are carried out before new staff start work in the home. This means that the home is sure that the staff they employ are suitable to work in this service. 64 of care staff at the home have successfully completed NVQ training. What has improved since the last inspection? What they could do better: Although assessments are undertaken of residents before they are admitted to the home, on a number of occasions some of the information was not used to develop care plans to address all the resident’s needs. Care plans were not detailed enough to give staff the information to deliver care and monitor it effectively. Risk assessments were often inaccurate and together with the care plans were not reviewed thoroughly enough to make sure that changes to residents’ needs were quickly identified and acted upon. Care was not always carried out as stated in people’s care plans and residents with a high degree of care needs were not monitored properly, leading to a risk to their health and safety. Poor care practices were raised with the nurse in charge on the first day of the site visit and a request made to address them as a matter of urgency. On the second day of the site visit, one of the matters raised had been addressed, but the other had not and an immediate requirement was made to protect the health and safety of one resident, as the care practices employed were putting them at risk. The manager has since written to the CSCI to inform us about how this matter was addressed. Some shortfalls in medicine procedures were identified. Cale Green Private Nursing Home DS0000017291.V351874.R01.S.doc Version 5.2 Page 7 We still received reports from residents at this site visit that staff attitudes to residents needed improving. This issue was raised at the last inspection and it is of concern that it has not been addressed. Although an activities organiser is employed at the home and a range of group activities and social events are provided, further consideration is required as to how social care needs can be met for residents not able to or not wishing to join in with group activities. A number of residents were in bed all day and were left alone for long periods of time. Morning routines were not good enough, in that, many residents were not offered anything to drink when they got up and the day staff did not serve breakfast until after 9.30am. Records of diet and fluids were not kept up to date, so tracking what residents were eating and drinking was poor. These matters were raised at the last inspection and no improvements were noted. The interval between breakfast and lunch was too short, not giving residents the chance to build up an appetite for the main meal of the day. Consideration needs to be given to the skill mix and numbers of staff to make sure that nurses have the time to properly plan care, ensure it is delivered effectively and monitor health care needs. Many of the residents are highly dependent and insufficient staffing levels were reflected in the lack of monitoring, poor standard of record keeping and challenging morning routine. Although most staff had received training in health and safety topics, such as fire safety and moving and handling, further specific training is recommended to ensure that staff have the skills and knowledge to properly deliver care to the residents. The manager has started a system to audit records and care practice within the home to ensure it meets the required standards, but needs to develop this further to ensure that when shortfalls are identified it is clear how they will be addressed and by whom. 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.V351874.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.V351874.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, 3 and 6 Quality in this outcome area is adequate. People are provided with satisfactory information about the home and prospective residents have their needs assessed before admission. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: A service user guide is available on request and is displayed in the reception area of the home. This contained all the information required in the National Minimum Standards. Cale Green Private Nursing Home DS0000017291.V351874.R01.S.doc Version 5.2 Page 10 Four residents were case tracked. Assessments had been undertaken for residents funded by the PCT or local authority, which were detailed and informative and staff had transferred this information onto the admission assessment forms used at the home. However, sometimes information was contradictory, for example, stating in one part of the assessment that a resident could transfer with the help of two carers and a frame, whilst another part of the assessment stated that the resident needed hoisting. Some care needs that were detailed in the assessments had not been addressed in the care plans. One resident had been admitted from home and although the manager had undertaken a pre-admission assessment, it was evident that she had not actually seen the resident, as parts of the form stated that the resident would have to be assessed on admission. The manager confirmed that she had not seen the resident pre-admission and had obtained details about the resident’s care needs from her relatives. It is good practice for any prospective resident to be visited by someone from the home prior to their admission in order to ensure that a thorough assessment is completed and all relevant information obtained. This enables an accurate decision to be made as to whether the person’s needs can be met. Cale Green offers an intermediate care service (step up and step down). Cale Green Private Nursing Home DS0000017291.V351874.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 poor. Systems and practice for monitoring the healthcare needs of residents are not consistent. This means that residents’ personal, health care or social needs may not be met. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Four residents were case tracked. Records generally were insufficient to enable staff to understand the care they needed to provide and did not fulfil the purpose of enabling staff to properly monitor the residents’ progress and condition. The following issues were identified: Cale Green Private Nursing Home DS0000017291.V351874.R01.S.doc Version 5.2 Page 12 • Care plans were not always in place to address residents’ identified needs. Care plans that did exist were not detailed enough to give a good overview of the resident’s needs and were not reviewed adequately. This meant that changes to the residents’ conditions were not always identified and addressed, for example, care plans and risk assessments for one resident who had been in hospital were not reviewed either before or after re-admission to the home. Risk assessments were inaccurate, for example, residents who were underweight were assessed as being of average weight and this meant that they were perceived to be at lower risk of malnutrition or pressure ulcers than they actually were. Other factors, such as neurological conditions, were also not calculated in the risk assessments, and risk assessments were not reviewed at the same time as other observations were taken, so up to date information was not used, for example, residents were weighed but their nutritional risk assessments were not then reviewed. Risk assessments were not always dated so it was not possible to tell how relevant or up to date they were. Risk assessments had not been undertaken at all for one resident who had been admitted to the home 48 hours previously. Care plans had also not been written, although the daily record for the resident referred to the care plans and said that care had been carried out in accordance with the plans! Care plans did not contain information about the type of pressure relieving equipment being used by residents and did not state, where necessary, the correct pump setting for the equipment. This meant that the staff did not know what the pump setting should be and two of the residents were being nursed on mattresses where the pumps were set incorrectly. This put them at risk of skin damage. This matter was brought to the attention of the nurse in charge on the first day of the site visit and the mattresses were set correctly on the second day of the site visit. Where care plans identified that residents’ fluid intake should be monitored, staff had not completed the records properly. Incomplete records mean that staff do not have all the information to accurately assess if the residents are drinking enough. From information recorded on the charts we had concerns that some residents were drinking insufficient fluids but there was no clear process identified by the care plans as to what action should be taken, and at what point, if a resident’s fluid intake was poor. Similarly, where care plans stated that residents needed to be assisted to change their position, charts to record this were not consistently maintained so it was not possible to evidence that the care given was as stated in people’s care plans. DS0000017291.V351874.R01.S.doc Version 5.2 Page 13 • • • • Cale Green Private Nursing Home • Staff need to demonstrate better diligence and professional knowledge in respect of monitoring all aspects of the health needs of service users. For example, care was not given to one resident as it was stated in their care plan, leading to a clear risk to the resident’s health and safety. This matter was brought to the attention of the nurse in charge on the first day of the site visit. On the second day of the site visit there had been no changes to the resident’s care and we still had concerns about their health and safety. An immediate requirement was made that this person’s care plans were reviewed and arrangements put in place to ensure they received the correct nursing care and monitoring to reduce risks to the resident. The manager confirmed in writing the steps she had taken to address the issues that were identified. We had concerns during the site visit that staff were not checking on bed bound residents often enough. We checked one resident on numerous occasions between 09.30 and 15.30 on the first day of the site visit and the resident concerned was always lying in the same position and their chart indicated that there were long gaps between staff coming to attend to them. • Of the four residents case tracked, one resident’s care plans were slightly more detailed and there was evidence that they had been discussed with the resident’s representative. Before the site visit the CSCI sent surveys to residents and relatives asking about their views of the home. Four relatives responded and, of these, two said continuity could be improved and communication was poor between staff and management, leading to a lack of information to carers regarding the residents’ needs. One relative said they were not kept informed about changes to the resident’s condition and said they had observed problems with communication with some staff. However, one relative said they had always been well satisfied with the general standard of care and attention that their relative received and several relatives were spoken to on the day of the site visit who said they were happy with the level of care being provided. Nurses spoken with had read the home’s medication policy, but the copy in the medication administration record file differed from the copy in the main office file. To ensure consistency in the handling of medication, there should only be one medication policy. A sample audit of records and blistered medication showed that most medication was administered as prescribed. But, some medicines were not always administered from residents’ own supplies making it impossible to audit (track) their correct use. Cale Green Private Nursing Home DS0000017291.V351874.R01.S.doc Version 5.2 Page 14 The manager was looking at the way medicines were ordered. The main monthly delivery of medication came when needed but residents were at risk of missing doses of medication that needed to be ordered at a different time. In one case, a resident was without one of their medicines for a week. The manager had recently made changes to try and improve the handling of prescribed creams. Although the records were generally up-to-date, it was too early to tell whether the changes would bring about an improvement overall. One resident’s cream was kept in their room when the label said it should have been kept in the fridge. Records showed another resident had ‘run out’ of their cream. Arrangements were in place for residents with minor ailments, such as mild pain, to have treatment without delay (home remedies). Residents wishing to manage some of their own medication were supported do so but written risk assessments were not always completed. These are needed to ensure residents always receive the support they need to manage their medicines safely. Records of the receipt of medication into the home and of unwanted medication sent for disposal were maintained. The handling of controlled drugs was correctly recorded, but there were two bottles of an unwanted controlled drug awaiting destruction. It was not possible to tell whether the CD cupboard met current legislation; the manager should confirm this to ensure these medicines are stored correctly. During the last inspection some residents said that the attitude of some of the night staff was poor and a recommendation was made that more consideration was given to ensure that all residents were treated in a manner that respected them and promoted their dignity. Several residents complained to the expert by experience about “rough handling” by staff and one resident commented “I don’t like the night staff they shout but the day staff are lovely”. Another resident said “during the day staff will answer when I ring the bell but night staff sometimes don’t bother” and she also said “they get angry if you call them too often at night so I try not to”. It was observed that one carer spent some considerable time trying to understand what one resident with speech difficulties was trying to say, displaying empathy and patience. Cale Green Private Nursing Home DS0000017291.V351874.R01.S.doc Version 5.2 Page 15 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 adequate. Some opportunities exist for people to engage in social activities but a lack of person-centred planning in respect of social and dietary needs means that some people’s social, dietary, cultural and recreational expectations may not be met. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: An activities organiser is employed at the home and a programme of activities and social events was displayed in the reception area. Activities included outings, bingo, arts and crafts, sing-alongs and board games. The activities organiser explained that they organised birthday parties for residents and were planning a pantomime at Christmas. Some of the residents are members of the Film Club and they watch DVD’s of their choice. There are no activities at the weekend or on Tuesdays, as the hairdresser visits the residents. Cale Green Private Nursing Home DS0000017291.V351874.R01.S.doc Version 5.2 Page 16 During the site visit the activities organiser spent time in the lounges on both floors, playing bingo with groups of residents who seemed to enjoy themselves. Many of the residents seemed to be quite highly dependent and several stayed in bed all day. These residents were left on their own for long periods of time. Social assessments and histories had not been completed for any of the residents who were case tracked and no care plans had been written to address their social care needs. Little information was provided about how residents had spent their day. It was reported that the activities organiser did spend time with the more highly dependent residents on a one-to-one basis but it was not clear how that time was spent. One resident being nursed in bed, observed for several hours, was left unattended for long periods with no visual or mental stimulation. The television in the room was on, without the sound and with a “snowy” screen. Residents said their visitors were made welcome at the home and it was noted that staff were happy to telephone and arrange taxis to pick up relatives when requested. At the last inspection it was reported that residents often had to wait for a long time for a drink when they got up in the morning. This site visit started at 8:30am and seven residents were sat in the first floor lounge waiting for breakfast. Two residents had drinks but the other five did not. At 9:15am, five residents were sat in the ground floor lounge waiting for breakfast. One resident said she was very hungry, as she had not eaten much for tea the previous evening. This resident had got up at 6:45am but had not been offered a drink. Two other people said they had got up at 7am and 8am but had not been offered drinks. Charts in residents’ rooms did not record that most residents had been given any drinks in the early morning. One resident said “I have to wait ages for a drink and something to eat in the mornings why can’t I have my breakfast when they get me up?” The menus did not state if a cooked breakfast was available; however several residents were seen eating bacon sandwiches or poached eggs on toast. One resident said their bacon sandwich was “tasty”. Most of the residents said the food was satisfactory, once they got it. Most residents were served breakfast between 9:30am and 10:30am. Lunch was served at 12:30pm. Mealtimes need to be reviewed to ensure that the intervals between are a suitable time to allow residents to digest meals and build an appetite. Cale Green Private Nursing Home DS0000017291.V351874.R01.S.doc Version 5.2 Page 17 Menus operated over a four-week period and residents said staff came and asked them what they wanted for lunch and tea. The meal on the day of the site visit was gammon and egg, chips and peas or quiche. Dessert was carrot cake or fresh fruit salad. The teatime menu offered crumpets and cheese or ham and mustard rolls and salad with a jam doughnut or arctic roll for dessert. Two residents needed a blended diet. The two carers who were feeding these residents were not sure what the food actually was; one thought it was sausage meat, mixed vegetables and gravy. Staff should know what the meal is so they can explain to the residents what they are being offered to eat. One carer was observed offering a resident food that they were not supposed to eat according to their specific diet. The resident was able to say that they should not eat the meal and the carer removed it and provided an alternative. However, staff need to be clear about specific diets that residents require to ensure that the correct meals are offered. In the ground floor lounge several residents were observed with their meals in front of them but not eating and falling asleep. Since the last inspection, one of the ground floor communal rooms has been made into a dining room. At lunchtime there were nine empty places in the dining room. Encouraging residents to move from the lounge to the dining room may enable staff to supervise and prompt people to eat better and residents may be more alert if they were encouraged to move. One resident told the expert by experience, at 1:45pm, that they had not been given any lunch and at 2:30pm they were calling for assistance and said “I am still waiting for something to eat”. The manager said that a survey had been undertaken to gain residents’ views about the meals. The results of these had been analysed and the manager said the menus were going to be reviewed in the light of the comments. Cale Green Private Nursing Home DS0000017291.V351874.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. Residents can in the main be confident that complaints will be treated seriously. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: A complaints procedure is available in the service user guide and a copy is also provided in each resident’s room. A record of complaints received had been maintained, together with action taken to resolve the issues raised. Four relatives returned surveys and of these, three said that they knew how to make a complaint and their concerns were always responded to appropriately. One relative said concerns were not always followed up. A large number of staff have now attended the ‘Alerter’ training provided by Stockport’s Social Services and other staff had received training in safeguarding adults via a DVD and supplementary questions to test their understanding of the information. Cale Green Private Nursing Home DS0000017291.V351874.R01.S.doc Version 5.2 Page 19 One staff member was fully aware of the procedures to follow but one was less sure about the procedures to follow if they wanted to refer any concerns to an external agency. Cale Green Private Nursing Home DS0000017291.V351874.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 and 26 Quality in this outcome area is good. Residents live in a safe, well maintained home that was generally clean and odour free. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: A tour of the home was conducted. Most of the home was generally clean and tidy, although some of the bathrooms were quite cluttered with equipment, such as hairdryers, commode pots, fans and bedpans. The manager said that these bathrooms were not used a great deal as most residents preferred to use the Parker bath, which was installed in a larger, tidier bathroom. Cale Green Private Nursing Home DS0000017291.V351874.R01.S.doc Version 5.2 Page 21 Bedrooms had been personalised with photographs, ornaments and small items of furniture. Two of the bedrooms on the first floor were having new carpets fitted; it was noted that one of the carpet fitters was working in the room whilst the resident was still in bed! A variety of equipment was available in the home to ensure the physical care needs of the residents could be met in a timely manner. The ground floor lounge was very gloomy and not suitable for residents wishing to read, do crosswords or engage in handicrafts, such as sewing or knitting. The globe shades had been removed from several of the light fittings leaving just the electrical wires on view. This was noted on the first day of the site visit and was unchanged on the second day a week later. The manager said that the owner was informed each week about routine maintenance work that needed to be undertaken and he then arranged for the work to be carried out. Arrangements should be such that routine maintenance work is undertaken promptly to avoid inconvenience to the residents. The ground floor dining room was nicely presented with the tables dressed with cloths, glasses and crockery. The first floor does not have a dining room and therefore provides little opportunity for residents to fully experience their meals as part of a wider social occasion. The owner said that new TV points had been provided in all the bedrooms, and two large plasma TV’s were being purchased for the lounges, together with an induction loop system, to enhance the enjoyment of residents with visual or hearing difficulties. Of the four relatives who returned comments cards two expressed particular satisfaction with the cleanliness of the home, one saying “the home is kept clean and doesn’t have that aroma that you get in a lot of places, very pleased with the cleanliness” and another saying, “cleanliness of both room and resident always noticed when visiting”. Cale Green Private Nursing Home DS0000017291.V351874.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. Further consideration is required to ensure that enough staff with the skills, knowledge and competence to meet residents’ needs are provided at all times. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: On the day of the site visit there were two nurses and five carers on the first floor until 2pm (we were told this was usually until 4pm) and then one nurse and five carers until 8pm. One nurse and four carers were on duty on the ground floor until 8pm. At night, there are usually four carers and one nurse to cover the whole home. The home offers a ‘step up’ facility on the first floor for short-stay residents who need additional care and support on a short-term basis. As the majority of these residents have a lot of care needs, during the day one nurse and one carer are designated specifically for these residents. Cale Green Private Nursing Home DS0000017291.V351874.R01.S.doc Version 5.2 Page 23 The issue of insufficient staffing to meet residents’ needs has been identified at previous inspections and again at this site visit it appeared from the length of time that people were left unattended and the amount of supervision staff could give residents, the time taken to serve breakfast and the poor record keeping, that staffing levels were not enough to meet the residents’ high dependency needs. The expert by experience sat for a while in the downstairs lounge, hoping to observe interaction between staff and residents but reported that, for the most part, residents were left unsupervised. Two staff personnel files were examined. Each file contained a copy of the application form, confirmation of Criminal Record Bureau checks, two references and items confirming proof of identification. It was recommended that references were checked for authentication. The manager reported in the AQAA that 64 of care staff at the home had successfully completed NVQ level 2 training. The manager is in the process of updating and transferring all staff training records from paper copies to an electronic record. Available records showed that most staff had received training in fire safety, safeguarding adults, and moving and handling. Several staff had undertaken some training in dementia care, one person had undertaken first aid and one nurse had attended training regarding immunisation. 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. Cale Green Private Nursing Home DS0000017291.V351874.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38 Quality in this outcome area is adequate. Further work is needed to ensure systems are in place to monitor care practices and record keeping to identify areas for development and improvement and to safeguard the interests and well being of residents. This judgement has been made using available evidence, including a visit to this service. Cale Green Private Nursing Home DS0000017291.V351874.R01.S.doc Version 5.2 Page 25 EVIDENCE: Since the last inspection a new manager has been appointed, who has worked at the home as a nurse for a number of years. Staff said that the manager was supportive, that she spent time out and about the home and that there had been several staff meetings since her appointment. The manager has begun the process to register with the CSCI. A residents meeting was held on 29th August 2007 and minutes were recorded for the information of people who could not attend. A quality assurance survey was sent to residents and relatives in September 2007 and it was reported that the responses to this were being analysed. Residents had also been asked for their feedback regarding the food provided by the home and their comments were being incorporated into new menus, which were being reviewed at the time of the inspection. A summary of a resident survey was available but was not dated, so it was unclear how recent this information was. In the reception area a suggestion box was provided and resident/relative survey forms were on display for people to take and complete if they wished. There was evidence that the manager had been undertaking audits regarding various aspects of care, such as care planning and medicine procedures. However, although various shortfalls had been identified, it was unclear then who had the responsibility for addressing the shortfalls and in what timescale. It was not possible to tell from the records if the shortfalls had been dealt with and practices improved as a result. The manager had not provided any information in the AQAA requested prior to the site visit, to demonstrate how some areas of concern identified at the last inspection had been addressed. These concerns included areas such as staff attitudes and provision of early morning drinks, both of which were still assessed as being problematic at this site visit. Procedures for the management of residents’ money were satisfactory. Staff said there was enough equipment within the home to enable them to carry out their jobs safely and staff were seen to be working using safe working practices. Cale Green Private Nursing Home DS0000017291.V351874.R01.S.doc Version 5.2 Page 26 An environmental health inspection was conducted on 8th February 2007. The report from this showed that some issues were raised informally. A brief inspection of the kitchen confirmed that the majority of the matters raised had been addressed. Regular checks had been made of the premises and equipment to ensure that everything was in good working order and well maintained. Records showed that a fire drill had been held on 22nd January 2007 (time not stated) and at 11:45am on 23rd March 2007. All staff should participate in fire drills twice a year and a record should be maintained to evidence this. Cale Green Private Nursing Home DS0000017291.V351874.R01.S.doc Version 5.2 Page 27 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 Cale Green Private Nursing Home DS0000017291.V351874.R01.S.doc Version 5.2 Page 28 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 2 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X 2 3 STAFFING Standard No Score 27 2 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 1 2 Cale Green Private Nursing Home DS0000017291.V351874.R01.S.doc Version 5.2 Page 29 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 OP3 Regulation 14 Requirement The manager must ensure that all details obtained about new residents during their assessment are fully considered when planning their care to ensure that all their needs are met. The manager must have in place detailed care plans and risk assessments which reflect the changing needs of service users and the up to date action required. This includes assessments and care plans for pressure area care, moving and handling and the provision of diet and fluids and social stimulation. (Timescales of 28/02/05, 28/02/06 and 30/03/07 not met). The manager must ensure that staff carry out residents’ care as stated in their care plans and risk assessments and conscientiously monitor the care provided to ensure the residents’ safety and well being. Timescale for action 15/11/07 2 OP7 12 15/11/07 3 OP8 13 15/11/07 Cale Green Private Nursing Home DS0000017291.V351874.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. 4 Standard OP8 Regulation 14(4)(c) Requirement The manager must ensure that the resident identified during the site visit has their care plans reviewed and must put in place arrangements to ensure that the resident is, at all times, suitably positioned to reduce risks to their health and safety whilst their feed is in progress. When residents manage their own medicines, written risk assessments need to be completed to ensure residents always receive any support needed to do so safely. The ordering systems need to be robust to ensure medicines do not normally run out and that medicines are administered from residents’ own supplies. 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 28/02/07 not met). Timescale for action 12/10/07 5 OP9 13(2) 15/11/07 6 OP9 13(2) 15/11/07 7 OP15 12 15/11/07 Cale Green Private Nursing Home DS0000017291.V351874.R01.S.doc Version 5.2 Page 31 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. 8 Standard OP27 Regulation 18 Requirement The manager must ensure that the service has suitably trained staff in sufficient numbers on duty at all times to support the needs of service users. (Timescale of 28/02/07 not met). The manager must ensure that systems are in place to check care practices and improve identified shortfalls. Timescale for action 15/11/07 9 OP33 24 30/11/07 Cale Green Private Nursing Home DS0000017291.V351874.R01.S.doc Version 5.2 Page 32 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 The registered person should ensure that care plan interventions are developed further to include more person centred information about each resident’s needs and preferences and explains how these needs are met. Prescribed items that are out of date should be safely disposed of as soon as possible. To ensure controlled drugs are correctly stored the manager needs to confirm that the CD cupboard meets current legislation. The medication policies need to be reviewed into one comprehensive policy to ensure consistency in the handing of medication. The manager should ensure that all residents are treated in a manner that respects them and promotes their dignity. The manager should ensure that all service users are consulted regarding their preferred social activities and ways in which their individual social needs can be met. The registered person should ensure that care records detail information about the residents’ involvement and enjoyment of activities participated in and this includes one to one activity. The manager should ensure that staff are familiar with and knowledgeable about the special diets required by residents to ensure that they are able to offer residents food that is suitable for them and to ensure that they are able to inform residents about the meals available. The manager should ensure that staff continue to attend Stockport’s ‘Alerter’ training. The manager should ensure that routine maintenance jobs are completed as quickly as possible to minimise disruption to the residents. The manager should ensure that the training matrix is up to date with the correct information and a training plan is developed and followed. 2 OP9 3 4 5 OP10 OP12 OP12 6 OP15 7 8 8 OP18 OP19 OP30 Cale Green Private Nursing Home DS0000017291.V351874.R01.S.doc Version 5.2 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 9 Refer to Standard OP38 Good Practice Recommendations 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. Cale Green Private Nursing Home DS0000017291.V351874.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Manchester Local Office 11th Floor, West Point 501 Chester Road Old Trafford Manchester M16 9HU 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. Extracts may not be used or reproduced without the express permission of CSCI Cale Green Private Nursing Home DS0000017291.V351874.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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