Inspection on 30/01/07 for Cale Green Private Nursing Home

This inspection was carried out on 30th January 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 03/10/07

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 Tracey Rasmussen Unannounced Inspection 30th January 2007 07:30 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.V326660.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.V326660.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cale Green Private Nursing Home Address Adswood Lane West Stockport Cheshire SK3 8HZ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0161 4771980 0161 480 0989 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.V326660.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. 1st August 2006 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 £1000 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.V326660.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors undertook this second unannounced key inspection site visit on the 30th January 2007. This means the home did not know in advance we were going. The inspection included a review of all available information received by the Commission for Social Care Inspection (CSCI) about the service provided at the home since the last key inspection on 1st August 2006. An unannounced random pharmacist inspection visit was also undertaken on the 5th October 2006 to see if the medication practice in place was safe, and that residents were receiving their medication as they should. A meeting was also undertaken with the registered provider in early November 2006 (with the CSCI) so that the registered provider could tell us how he was going to improve the care service provided in the home. A new manager is now in place, and some areas of improvement had been made in the service to residents since the last inspection visit but more improvement is needed in a number of areas. All key inspection standards were assessed at the site visit and information was taken from various sources which included observing care practices, talking with residents; talking with visitors; interviewing the manager and other members of the staff team. A tour of the home was also undertaken and a sample of care, employment and health and safety records seen. A brief explanation of the inspection process was provided to the manager of the home at the beginning of the visit and time was spent at the end of the visit to provide verbal feedback to the manager and to the responsible person of the initial findings. What the service does well: Residents were on the whole positive about the home. Comments included ‘I am comfortable’; ‘Day staff are all fine’; ‘I don’t have to worry living here – no cooking or laundry’ and ‘Yes the staff are very good’. One relative said that her loved one was looked after properly and she was happy with the care. 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. Cale Green Private Nursing Home DS0000017291.V326660.R01.S.doc Version 5.2 Page 6 The home was clean and generally odour free, and all bedrooms had had new curtains and some bedrooms had been redecorated and re-carpeted. The manager said that a rolling programme of redecoration was being undertaken. What has improved since the last inspection? What they could do better: Despite the manager’s hard work and progress in trying to improve the quality of care services in the home, a number of areas of importance continue to require improvement and these are explained below. Morning routines were not good enough in that residents were not offered anything to drink when they got up and the day staff did not serve breakfast until after 9.30am. This resulted in some residents not getting a drink for almost four hours after they had got up. This practice could lead to dehydration and poor diet. Records of diet and fluids were not kept up to date so tracking what residents were eating and drinking was poor. One resident said she had ‘to wait for ages and ages for her breakfast and a cup of tea.’ Lunch was also served very late. Another residents said, ‘they are short staffed a lot but if you press the buzzer they come as a rule.’ Cale Green Private Nursing Home DS0000017291.V326660.R01.S.doc Version 5.2 Page 7 Staff attitudes to residents need improving. Residents were not complimentary about the night staff, one said ‘the night staff are not very nice, they moan when you call them and they are not very friendly’ and another residents said the ‘night staff can bit a bit off’ and also said that the night staff have been into her room at times and taken her call bell so she could not get them when she wanted. One resident said the staff didn’t listen to her concerns, so it was pointless complaining. Day staff said they felt there was enough of them to do their job, however they were frequently asked to help out on the short stay ‘step up’ unit leaving other residents in the home waiting for care and attention. Morning routines observed on the first floor did indicate staffing levels were not good enough to make sure residents got care and attention in a timely manner. Resident’s care plan records need improving so that assessments and care plans are recorded every time for all individual care needs. This means that information about health and personal care and the resident’s personal wishes, likes and dislikes should also be included in the care plan and the resident’s agreement to the plan obtained. Pre-admission assessments need to be recorded for each resident and these must be detailed. Evaluation of care plans needs to be undertaken so that the effectiveness of the care provided to residents is reviewed and changed if necessary. Staff need to dispose of used incontinence products safely so residents are protected from cross infection. Medication practices need to improve. Medication records were not kept up to date, which could possibly put residents at risk from either getting too much medication or not getting enough medication. Records of medication coming into the home need to be made and staff need to sign and date any changes made on the medication sheets. Staff need to ensure no overstocking of medication or supplements occurs so that all stocks can be safely used before the ‘use by’ date runs out. Social activity and stimulation needs improving. Residents and staff spoken with said recently there was not much going on. Some staff training had been provided for fire safety and moving and handling, however records were only partly up to date and a training plan for further training needs developing. Nursing staff need to attend Stockport’s ‘Alerter’ training in abuse. Quality assurance monitoring and auditing of the care services needs improving so that continuous improvements are made in the home. The responsible person for the home should do regular monitoring visits (regulation 26) and send copies of these to the CSCI. The manager must provide an application form to be registered with the CSCI. Routine maintenance, fire safety and fire drill records and food health and hygiene practices in the kitchen need improving. Cale Green Private Nursing Home DS0000017291.V326660.R01.S.doc Version 5.2 Page 8 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.V326660.R01.S.doc Version 5.2 Page 9 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.V326660.R01.S.doc Version 5.2 Page 10 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): Quality in this outcome area is adequate. The home’s assessment procedures were not consistently robust enough to confirm that they could meet the needs of the resident on admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Six care files were reviewed in the home. These were taken from both of the floors in the home. Five of the care files provided some information about the care needs of the residents. This information was basic and did not always detail the clearly what the need was or how the need was to be met. Information regarding personal choices and preferences was not recorded and one resident’s care file did not have a pre-admission assessment available. Cale Green Private Nursing Home DS0000017291.V326660.R01.S.doc Version 5.2 Page 11 One care file for a short stay resident had information available from a care manager. This information was not very detailed. Comprehensive community care assessments were not always available with the residents care files and it was unclear if these were consistently sought and obtained. These should be obtained as they provide additional information about the prospective resident and this may help the home provide a more individual service. A copy of Statement of Purpose and Service User Guide were available at entrance to the home. These were not reviewed. The manager did report that the information in both guides had been updated. The home does not provide an Intermediate Care Service (Standard 6) Cale Green Private Nursing Home DS0000017291.V326660.R01.S.doc Version 5.2 Page 12 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): Quality in this outcome area is adequate. Residents receive care and support, on the whole in a respectful and dignified manner. Most of the care planning documentation was not sufficient to meet the personal and health care needs of residents. This means some care needs were not met in practice. Staff do not fully follow the policies and procedures in place, which potentially places some residents at risk of not receiving their medication appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents seen and spoken with were reasonably presentable. Residents provided a mixture of comments both praising and criticising the service provided in the home. Positive comments included; ‘Day staff are all fine – they are short staffed a lot but if you press the buzzer they come as a rule’; ‘I don’t have to worry living here – no cooking or laundry’; and ‘Staff are nice and smashing’. Cale Green Private Nursing Home DS0000017291.V326660.R01.S.doc Version 5.2 Page 13 Negative comments were mainly made about the attitude of the night staff and comments included ‘The night staff are not very nice, they moan when you call them and they are not very friendly’; ‘I am got up at about 6.45 every morning because staff have things to do’ and ‘I was told to stop pressing the call bell by a nurse’. Two residents said that their call bells had been left out of reach on occasion. Relatives spoken with were positive, one said ‘Staff are lovely, always cheerful’ and indicated her relative ‘does get (their) care needs met’. Staff spoken with were positive about working in the home. Staff said they were trained and supported to do their job and several had achieved a NVQ 2. Early morning care practices did not always promote resident wellbeing or health and safety. Night staff disposed of used incontinence products unhygienically, which could lead to cross infections and residents, were not offered a drink upon getting up. Resident’s dignity was not always promoted, one resident was left with porridge in his lap and staff did not appear to notice. The manager in the home had undertaken an audit of the care plans in the home and he was working with individual nurses to ensure care plans were consistent and up to date. He acknowledged that this was a long standing area of development and that more work was needed, but said he was confident that care plans would improve. Care plans were seen from both floors in the home and these did not provide information about the needs of each resident, which meant care needs for some residents were not met. Six care planning records were seen. One resident on the ‘step up’ unit did not have any assessments or care plans. The quality of the information recorded in the remaining care plans was variable. The care plans did not include information about the resident’s personal preferences, likes, dislikes, wishes or needs. Care assessments for example for nutrition and moving and handling were not recorded properly making the assessments inaccurate or incomplete and care plans were not always recorded when a need was identified. One resident’s care file indicated a large weight loss, and actions to monitor this were recorded, however monitoring of diet and fluid intake was not recorded, in accordance with the care plan. Another resident had not been weighed since admission (several months previous) making the nutritional assessment invalid. There was little evidence that residents had been consulted or had agreed to the plans for support that were in place and evaluations of care plans were also not good enough in that they consisted of a review date with no Cale Green Private Nursing Home DS0000017291.V326660.R01.S.doc Version 5.2 Page 14 information about the effectiveness of the care delivered or the progress achieved with the resident. Other monitoring records such as fluid intake records were not completed appropriately. The home’s morning routines were task focused and not resident focused, this meant residents were left long periods before breakfast were served or a morning drink offered. Diet and fluid charts were not recorded accurately therefore checks to ensure residents were getting enough fluid and diet were of no value. Records of contact with community health services such as GP, tissue viability speech therapy and optical support were available. Reference to the use of chiropody services was not recorded. The manager stated that he had recently undertaken a full medication audit and identified a significant number of issues. The manager confirmed that actions to address the shortfall in medication practices had not been taken, however a plan was being developed to address these and he was confident that medication practices would improve. This visit did identify a number of areas of inadequate medication practice all of which could potentially put the health of residents at risk. The medication administration records contained gaps in the records, which indicated that medicines had either not been administered when prescribed or not signed for when administered. Medication sheets did not consistently use the correct code nor were the amounts of medication entering the home always recorded. This means that there was not a complete audit trail of medication prescribed for residents. Several medication sheets had medication blacked out with a marker pen and it was unclear if the home or the supplying pharmacist had done this. Some medication in one fridge should have been disposed off and stocks of food supplements were very high. A number of these were out of date and should have been disposed off. Cale Green Private Nursing Home DS0000017291.V326660.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. Resident’s lifestyle preferences and choices were not always promoted by the routines and task focused service provided in the home, although visitors were welcome at anytime. Meals provided were varied and nutritious but meal serving times were not provided at resident’s preferred times and therefore did not promote their wellbeing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager reported that the home’s activity person was leaving and they were actively trying to recruit someone. At this visit no activities were seen. The activity person was not on duty. Information was displayed in the home and in bedrooms detailing what activities had been planned for the month of January 2007. There was no information for February. Records of who had joined in or enjoyed the advertised activities was not available. Some information was recorded in the Cale Green Private Nursing Home DS0000017291.V326660.R01.S.doc Version 5.2 Page 16 care plan records but this information was basic and did not reflect personal choices, preferences or wishes of residents. One resident’s care plan stated that they liked playing dominoes, was sociable and liked to chat. The resident said, “I have been out shopping and to the bank. There are no other activities but staff do pop in now and again” Another resident said, “I don’t get involved in activities – I enjoy my paper.” Care staff spoken too said that the activity person did undertake activities, but the activity person was leaving. Care staff said they did not have time to do activities because they were very busy. The manager confirmed that he was trying to recruit a new staff member for the activities job. Residents spoken with said their wishes regarding staying in their bedrooms were respected. One resident did say she had to get up when staff were available because they were too busy and she accepted this. One resident confirmed she was provided with a bath at a frequency she was happy with and a relative said that her loved one received a bath almost every other day, as this was their preference. A visitor confirmed ‘Relatives and visitors are always made welcome’. Visitors were seen in the home throughout the visit. Residents were generally positive about the quality of the meals provided in the home. One resident said “The food is quite good and I enjoy it” and ‘…people ask what you want off the menu but it’s not like what you cook yourself though.’ Another resident said “I have a good breakfast every morning.” And a relative said the ‘food is very good’. Breakfast was served on the ground floor at about 9.30am. Residents were provided with a selection of meals which included porridge scrambled egg, fried egg and bacon, bread and toast. All residents appeared to be enjoying breakfast. Not all comments were positive and one resident said the food ‘… was not so good’ and that she had ‘to wait for ages and ages for her breakfast and a cup of tea.’ Discussion with residents, care staff and observation of early morning practices identified that residents were not offered a morning drink upon rising. At least two residents were assisted to get up from about 05.45 am but did not receive a drink until four hours after getting up – when breakfast was first served. Other residents also confirmed they had been waiting ‘hours’ for a drink. Residents health and wellbeing needs were not protected or promoted by the above practice and action to ensure residents are provided with a drink of their preference must be taken. Cale Green Private Nursing Home DS0000017291.V326660.R01.S.doc Version 5.2 Page 17 The first floor of the home had a high number of very dependent residents who needed assistance with meals. The home had adapted it’s routines, so that all the residents on the first floor received their meals in a timely manner by bringing care staff up from the ground floor to assist residents. Residents on the ground floor received their meals on the ground floor after all the residents on the first floor had been served. At this visit both breakfast and lunchtime meals were served very late and the home must review it’s routines to ensure residents are provided with breakfast upon rising and lunch is served at a timely interval. The ground floor of the home has a dining area with dining tables set in a presentable manner. Residents on the ground floor had the option of sitting at the dining table or eating their meals in their room or from a small table. The top floor of the home did not have a dining room and residents were served meals on side tables. The opportunity to promote socialisation and go downstairs to eat in the dining room was not offered. Cale Green Private Nursing Home DS0000017291.V326660.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. Staff are trained to respond appropriately to suspected abuse. 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: Since the last inspection visit the manager had received three complaints and these had been responded to, according to the home’s complaints procedure. Records were available of all complaints and issues and the actions undertaken in response to each complaint were recorded. One regular visitor to the home said that if she had ‘any concerns I speak to the staff, they are all approachable’. However one resident said she felt she had no one to complain to and said ‘When you tell them something they ignore it so what’s the point’. In light of this comment the manager should review how staff respond to resident’s concerns. Most staff reported that they had received training in abuse and the protection of vulnerable adults and were able to discuss the content of their training and relate it to the home environment. Records were available of staff training. Staff also confirmed they had undertaken NVQ training and this also included information and training in abuse. Cale Green Private Nursing Home DS0000017291.V326660.R01.S.doc Version 5.2 Page 19 It was noted from the home’s training records that none of the home’ nursing staff had attended the ‘Alerter’ training provided by Stockport’s Social Services. All staff employed at Cale Green would benefit from this training. Cale Green Private Nursing Home DS0000017291.V326660.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): Quality in this outcome area is good. Residents live in a safe, well maintained home that was clean and odour free. . Specialist equipment is available which means the different needs of each resident could be met promptly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was clean and odour free and domestic staff were observed to be thorough in undertaking their duties. Resident’s bedrooms were warm and bright and had been made homely with their possessions. One resident said, “I have a nice room” and another resident said, “I am comfortable”. The manager said that all bedrooms had had new curtains and a rolling redecoration and re-carpeting programme was being implemented. A number of specialist easy chairs had been purchased and the manager stated that the Cale Green Private Nursing Home DS0000017291.V326660.R01.S.doc Version 5.2 Page 21 lift in the home may need upgrading in the future. One specialist bed, which was in use, had a faulty bedrail that was being held up by a bedside table. This was unsafe and the manager stated he would change the bed. The maintenance man was observed working in the home in the home. His duties included attending to the day to day repairs and general maintenance of the home. 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. Cale Green Private Nursing Home DS0000017291.V326660.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. Recruitment vetting practices, training and skill mix were on the whole, appropriate to meet residents’ needs and promote their health and safety, however staffing levels did not always ensure residents care needs were met in a timely manner. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 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. The majority of these residents had a lot of care needs and needed two staff members to provide care and support. The home does provide a dedicated care staff member and nurse to care for these residents but care staff spoken with indicated that this was not enough to meet the resident’s high dependency needs especially when the nurse was busy with other tasks. This resulted in care staff being moved from their duties to assist on the ‘step up’ unit, which resulted in residents in other parts of the home having to wait for care and service. The issue of insufficient staffing to meet residents needs has been identified at previous inspections. Cale Green Private Nursing Home DS0000017291.V326660.R01.S.doc Version 5.2 Page 23 Care staff also said they felt the management of the ‘step up’ unit was poorly organised through the week. The manager said he was aware of this and was in the process of addressing this. Three employment files for newer staff at the home were seen and all three had the required documentation and included, full working histories, CRBs (police checks) references and employment start dates. A training matrix had been partially completed and this detailed the training staff had received but did not consistently record the date the training was provided. Most statutory health and safety training had been provided although the dates of the training were not always recorded. Fire training was being provided by the local fire brigade at Stockport College. Most staff had done moving and handling training, four staff had done dementia training and four nurses had done medication training. Approximately 58 of care staff had obtained a NVQ2 qualification. A training plan was not available for future training. Cale Green Private Nursing Home DS0000017291.V326660.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, 36 and 38 Quality in this outcome area is adequate. The management of the home, on the whole, promotes the health, safety and wellbeing of the residents. Residents do have an opportunity to comment on how the home is run although systems to monitor and improve service quality could be better. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some areas of service had improved but significant areas of improvement are still required. The manager currently in post was the general manager for the company at the last inspection and therefore has not had a significant amount of time to improve all aspects of the service. The manager had not submitted a registered manager’s application form to the CSCI and this must be Cale Green Private Nursing Home DS0000017291.V326660.R01.S.doc Version 5.2 Page 25 addressed as soon as possible. The manager is a registered nurse and has a varied background of providing nursing care and support. Residents, relatives and staff said that the manager had improved the service. One staff member said, “It is much better. The team is much happier – we all get on.” The manager had undertaken some audits of the different aspects of service in the home and had been working towards the home’s improvement plan. A full medication audit had been undertaken recently and a number of areas of improvement had been identified. Similar failings were also identified by the inspection. It was reported that about twelve service user comment cards had been sent out recently but feedback from these was not available because the manager was waiting for more to be returned to provide a bigger picture of resident’s and relatives views on the home. Following the last key inspection of the home, an improvement meeting was held where it was agreed with the responsible person that he would keep the CSCI updated with improvements undertaken in the home and regulation 26 monitoring visits would be undertaken monthly and a report forwarded to the CSCI. To date no regulation 26 reports had been forwarded to the CSCI. Although the manager did state the responsible person had undertaken a monitoring visit recently. A small sample of records of resident’s personal monies were examined and these were maintained satisfactorily. Records of supervision of staff indicated some supervision had been provided but not all staff had benefited from this and this should continue. Health and safety maintenance and monitoring records were available, however water temperatures had been post dated and some records indicated that there had never been a problem since 2003, suggesting the records were a paper exercise. Electrical appliance testing was overdue, maintenance safety check records for the lift and manual handling hoists were not available although the manager gave an assurance that these had been maintained in accordance with legislation. Up to date records of staff fire drills were not available and food health and hygiene records in the kitchen were only maintained intermittently and open foods had not been labelled correctly. Cale Green Private Nursing Home DS0000017291.V326660.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 1 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 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 2 x 2 Cale Green Private Nursing Home DS0000017291.V326660.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 OP8 Regulation Requirement Timescale for action 30/03/07 2 OP9 3 OP15 OP8 4 OP27 12, 14, 15 The registered person must have in place detailed care plans, 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 and 28/02/06 not met). 13, 17 The registered person must ensure that there is an accurate up-to-date list of currently prescribed medication, and the date and time of administration for every resident. (Timescale of 01/10/06 not met). 12,13, The registered person must ensure diet and fluids are provided to residents in accordance with health care guidance, resident’s personal request and at reasonable intervals throughout the 24 hour day. 18 The registered person must DS0000017291.V326660.R01.S.doc 28/02/07 28/02/07 28/02/07 Page 28 Cale Green Private Nursing Home Version 5.2 ensure that the service has suitably trained staff in sufficient numbers on duty at all times to support the needs of service users. 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 OP3 Good Practice Recommendations The registered person should ensure that detailed preadmission assessment information is obtained before the arrival of a new resident so that appropriate care plans can be in place to meet the new resident’s assessed needs. The registered person should ensure that residents are consulted about their care and 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. The registered person should ensure after consultation with residents that care plans are evaluated for their effectiveness and this is recorded. The registered should ensure staff practices are safe and do not put residents at risk of cross infection through unsafe disposal of incontinence products. The registered person should ensure that medication ordering systems do not allow overstocking, stock rotation is undertaken and prescribed items that are out of date are disposed of immediately. The registered person must ensure that all residents are treated in a manner that respects them and promotes their dignity. This includes respectful attention when residents require or request assistance and care to the personal appearance. The registered person should ensure that all service users are consulted regarding their preferred social activities and ways in which their individual social needs can be met. 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. DS0000017291.V326660.R01.S.doc Version 5.2 Page 29 2 OP7 3 4 5 OP7 OP8 OP9 6 OP10 7 8 OP12 OP12 Cale Green Private Nursing Home 9 10 11 12 13 14 OP12 OP15 OP16 OP18 OP30 OP33 16 17 18 OP36 OP38 OP38 19 OP38 The registered person should ensure that an activity person is recruited for the home as soon as possible. The registered person should ensure residents accommodated on the top floor are offered the opportunity to dine in the dining room. The registered person should ensure that staff respond appropriately to all issues, grumbles and concern brought to their attention. To registered person should ensure that nursing staff attend Stockport’s ‘Alerter’ training. The registered person must ensure that the training matrix is up to date with the correct information and a training plan is developed and followed. The registered person must ensure quality assurance and monitoring is undertaken regularly in the home and this includes providing monthly regulation 26 reports to the CSCI. The registered person must arrange for all nursing and care staff to receive supervision at least six times annually. The registered person must ensure that all staff attend fire drill practice and training at least twice a year and sign alongside their printed name on receipt. The registered person must ensure that kitchen cleaning schedules, fridge and freezer temperatures and all other food safety matters are undertaken and that these are recorded in line with environmental health guidelines. The registered person should ensure that routine maintenance and planned service maintenance is kept up to date and a record kept on site to demonstrate this. Cale Green Private Nursing Home DS0000017291.V326660.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD National Enquiry Line: 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.V326660.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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