Inspection on 04/06/05 for Cambridge Nursing and Residential Care Home (The)

This inspection was carried out on 4th June 2005.

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

Cambridge Nursing and... 12/09/06

Cambridge Nursing and... 13/01/06

Cambridge Nursing and... 24/02/05

Cambridge Nursing and... 09/09/04

Cambridge Nursing and... 10/12/03

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

CARE HOMES FOR OLDER PEOPLE The Cambridge Nursing and Residential Care Home 61 Cambridge Park Wanstead London E11 2PR Lead Inspector Edi OFarrell Unannounced Inspection 04 June at 11.45 and 10 June 2005 10:30 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 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. The Cambridge Nursing and Residential Care Home G55_S0000037315_Cambridge NH_V231611_040605_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Cambridge Nursing & Residential Care Home Address 61 Cambridge Park, Wanstead, London E11 2PR Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8989 1175 Mrs Lillette Ebrahimkhan Mr Abdool Rashid Mahmadkhan Ebrahimkhan CRH Care Home 49 Category(ies) of DE Dementia (9) registration, with number DE(E) Dementia -over 65 (9) of places OP Old age (32) PD Physical disability (8) The Cambridge Nursing and Residential Care Home G55_S0000037315_Cambridge NH_V231611_040605_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 24 February 2005 Brief Description of the Service: The Cambridge Nursing and Residential Care Home is a privately owned care home with nursing for 49 people. It is registered to provide nursing and personal care and accomodation for both younger adults (18 to 65) and older people (65 plus). It is situated in Wanstead close to local shops and other amenities, and is well served by public transport. The home is a large, detached, property, set back from the main road with parking to the front, and an enclosed garden to the rear. The accomodation is spread over three floors, which are accessed by both stairs and a lift. The ground floor houses the kitchen and laundry, together with 17 bedrooms, a lounge, dining room, and conservatory. The first floor has 23 bedrooms, a lounge and a dining room, and the second floor has nine bedrooms and a lounge. There are toilets and bathrooms, with assisted baths, on each floor. Thirty five of the bedrooms are single, with 28 having an ensuite toilet. There are also seven double bedrooms, each with an ensuite toilet. The Cambridge Nursing and Residential Care Home G55_S0000037315_Cambridge NH_V231611_040605_Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This, unannounced, inspection took place over two separate visits, the first being on a Saturday afternoon and early evening, and the second on a weekday morning and early afternoon. The Proprietors, one of whom is also the Registered Manager, were at the home during the second visit, but not the first, when they were spoken to by phone. The Registered Manager was informed by phone at the end of the first day that a second visit would probably need to take place. He was contacted the day before the second visit and asked to have written information ready regarding the ages of all service users, the qualifications and experience of staff, and recruitment files relating to all staff recruited since the last inspection, as well as staff training records. All parts of the home were visited on the first day and the ground and first floor on the second. Care records were examined on both days, with a concentration on the younger adults on the second day. Where possible service users were asked to give their views of the service, and their experience of living in the home. For some people their level of disability meant that this was not possible, but other people were able to clearly express their views. Where relatives were visiting during the two days they were also asked for their views. Nursing and care staff were asked about the care that service users receive, and were also observed carrying out their duties during both visits. Information held on file by the Commission in relation to recent significant events was studied, as was information provided by the local Primary Care Trust (PCT) Review Team, who are currently reviewing many of the service users. On the second visit some of the staff recruitment and training records were examined. Eight Requirements and two Recommendation set at the previous inspection were checked for action to date. In the case of one Requirement the timescale for action has not yet been reached and this has been repeated with the original timescale. This report format is for care homes for older people, but there are currently 14 service users who are under the age of 65 so some sections of this report, including some Requirements, refer to the National Minimum Standards (NMS) for younger adults. Where the issues covered in the two sets of Standards differ e.g. Standard 2 for older people (OP) covers contracts, but Standard 2 for younger adults (YA) covers needs assessment, this is highlighted in the report. Service users, staff and relatives are thanked for their input to the inspection. The Cambridge Nursing and Residential Care Home G55_S0000037315_Cambridge NH_V231611_040605_Stage 4.doc Version 1.30 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The manager of the home needs to carry out regular checks on the quality of care being provided, ensuring that care is delivered in accordance with the individual care plans and the wishes of service users. This needs to include asking service users and their relatives, and staff what they think about the service the home offers. It also needs to include talking to some of the professionals who visit service users at the home, and making sure that the instructions they leave are followed. The owners of the home need to think about the range of nursing and personal care needs that they, and the staff group, are trying to meet, to ensure that they can provide a quality service to all users. It is currently very wide, covering younger and older people with both physical and mental health problems. They also need to think about how the space within the home is allocated, as people with different needs are currently mixed on each of the three floors. The Cambridge Nursing and Residential Care Home G55_S0000037315_Cambridge NH_V231611_040605_Stage 4.doc Version 1.30 Page 7 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 Cambridge Nursing and Residential Care Home G55_S0000037315_Cambridge NH_V231611_040605_Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection The Cambridge Nursing and Residential Care Home G55_S0000037315_Cambridge NH_V231611_040605_Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) OP1 & 3 & YA1, 2&3 Prospective service users, their representatives, and placing authorities could be misled by some of the information in the current Statement of Purpose, leading to inappropriate admissions. Appropriate assessments are carried out prior to admission to the home, and the information is being used by the home to set out written care plans, but this does not mean that all service users, and their representatives can be sure that all their needs will be met by the home. EVIDENCE: The Statement of Purpose (SOP) held on file by the Commission contains a section on `Overview of the Home’. This states that the home can meet the needs of adults with mental health problems, but the home is not registered to admit people where this is the primary diagnosis. This could mislead both service users and placing authorities, resulting in inappropriate placements. The SOP also still refers to the previous regulatory body. The Registered Manager confirmed that this document was the most up-to-date SOP. It needs The Cambridge Nursing and Residential Care Home G55_S0000037315_Cambridge NH_V231611_040605_Stage 4.doc Version 1.30 Page 10 to be reviewed in order to ensure that it accurately reflects the service that the home is registered to provide, and body that registers it. This is Requirement 1. Ten care files were examined; these were a cross section of older people and younger adults, and included two people who fund their own placement. Where community care assessments had been carried out by the placing Local Authorities there was a copy on file. There was also pre-admission assessment by the home, and the information had been used to continue assessment once the service user moved into the home, and to develop written care plans. Many of these care plans have been developed during the past two months, some in response to the recent reviews being carried out by the Primary Care Trust Review Team, and the placing social services department. The day-today practice in relation to the care plans is commented on in the next section of the report, Health and Personal Care needs, and relates to Requirement 2. The evidence to support Judgement 2 is also set out in the section on Health & Personal Care on pages 12 & 13 of this report. The Cambridge Nursing and Residential Care Home G55_S0000037315_Cambridge NH_V231611_040605_Stage 4.doc Version 1.30 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) OP7, 8, & 9, & YA19 & 20 Service users’ health, personal and social care needs are set out in an individual plan of care, but this does not mean that these are fully met on a day-to-day basis. The Commission has a particular concern regarding the health and social care needs of the younger adults living in the home. Referral to specialist health professionals, where there are potential complications and problems, is not always made promptly, nor their advice followed. Staff are still not fully complying with correct procedure in relation to the administration and recording of medication. EVIDENCE: Ten care plans were examined, and staff, relatives, and service users were asked about the care being provided. A visiting social worker, and a member of the Primary Care Trust Reviewing Team were asked for their views, and review feedback letters to the manager were examined. There is evidence that the writing of care plans has been given a high priority over the past few months. The system being used is comprehensive, and the care plans seen The Cambridge Nursing and Residential Care Home G55_S0000037315_Cambridge NH_V231611_040605_Stage 4.doc Version 1.30 Page 12 were clear, covering a wide range of health and personal care needs. There was evidence that some referrals had been made to visiting specialist health professionals, such as chiropodists, physiotherapists, and tissue viability nurses. There was also evidence that some referrals had not been made by the home, when all signs indicated that they should have been. In addition there was evidence that advice given by these professionals had not always been followed, or taken forward into the care plan. Examples are: One service user where the physiotherapist had developed a rehabilitation regime, which had not been followed and where the GP had asked for a referral to the Chiropodist, and this had not been done until it was necessary for the podiatrist to visit as an emergency; and advice provided by the nurse specialist in diabetes not being included in a reviewed care plan. The Commission is concerned about the ability of the home to meet the wide range of needs that the service users have, in particular the nursing and social care needs. The home currently has 14 service users who are under the age of 65, who have a wide range of physical, psychological, rehabilitative, and social needs and 30 people over the age of 65 who also have a wide range of physical and social needs. In all, these needs span long standing functional mental health problems, such as depression and schizophrenia, poorly controlled diabetes, including vascular complications, learning disability, challenging behaviour, rehabilitation following cardio vascular accident (CVA), and varying degrees of dementia and associated physical and psychological problems. A Requirement was set at the previous inspection that the registered persons must be able to demonstrate that the assessed needs of all service users are being met and that staff have appropriate skills and training in dementia. This was restated from a previous inspection and a timescale for action set for 30/06/05. As the timescale for this Requirement had not been reached by the date of these visits this has been restated as Requirement 2 and in addition Requirement 3 has been set. At the last two inspections a Requirement has been set that where handwritten entries are made on medication administration charts, these should be signed and dated. A sample of charts viewed on the first day of this inspection showed that this Requirement had not been complied with. This is Requirement 4. One of the Commission’s Pharmacist inspectors visited the home the day prior to the first day of this inspection, but was unable to carry out a full audit, as there was no record of medication received into or leaving the home. An Immediate Requirement was set, and a separate letter has been sent to the manager regarding this. This has been incorporated into this report as Requirement 5. The Cambridge Nursing and Residential Care Home G55_S0000037315_Cambridge NH_V231611_040605_Stage 4.doc Version 1.30 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) OP 12, 13, 14 & 15, and YA 11 to 17 The lifestyle within the home matches the expectations and preferences of some service users, but not others. In particular social and recreational needs are not well catered for unless family members arrange to meet them. Many of the service users enjoy the food, and stated that they have sufficient choice. The food provided does not correspond with the written records, so it is not possible to tell if the service users are receiving a wholesome, balanced and appealing diet. In addition the special dietary needs of some service users are not being appropriately passed onto catering staff. EVIDENCE: Standards 12 to 15 above relate to Older People, whereas in the Standards for Younger Adults they come under the heading of Lifestyle, Standards 10 to 16; both sets of standards were used in forming the above judgement. Service users, and where possible relatives, were asked their views, and the lifestyle of the service users was observed over the two visits, as well as care plans being examined. There appear to be two distinct types of lifestyle within the home: (1) where service users stay in their bedroom for most of the day watching television; or (2) where they are taken into one of the lounges. Three of the care plans examined specified that the service user should be The Cambridge Nursing and Residential Care Home G55_S0000037315_Cambridge NH_V231611_040605_Stage 4.doc Version 1.30 Page 14 taken for a walk (in a wheelchair if necessary) down the high street, or to the shops. In each of these cases the staff, when asked about this activity, said that relatives did this, but this is not what was written in the care plans. The lifestyle within the home is of particular concern in relation to the younger people, who were observed during both visits to be for the most part in their bedrooms. The Registered Manager and staff repeatedly stated that this was the service users’ choice, but little alternative stimulation was noted during the visits. The views of service users were sought, but they were not all able or willing to comment. Requirement 6 set at this inspection is restated from previous inspections. The home has a open policy in relation to visitors, who are free to visit in the lounges, conservatory or bedrooms. On the first visit the menus were examined, and discussions held with the cook, and on both visits service users were asked about the meals, and the meals served during the visits were seen. On the evening of the first visit the meal was supposed to be chicken nuggets and spaghetti; one service user was served scrambled eggs and tinned spaghetti, but everyone else on the ground and first floor had sandwiches. Service users confirmed that this was the normal evening meal. The sandwiches had the crust cut off so were very small. If the menu had been stuck to this would have meant two types of processed food in one meal i.e. tinned spaghetti and chicken nuggets, both high in salt and sugar. Requirement 7 has been set so that the Registered Manager seeks advice from nutritional experts about an appropriate menu for the home. In looking through the care records it was apparent that a wide range of diets has to be catered for, these included, high protein, low salt, diabetic, soft and puree diets. In visiting the kitchen only a limited amount of this information was available to the cook, though she stated that the care staff informed her on a daily basis as to which types of diets are needed. This is Requirement 8. The second visit occurred on a Friday, when lunch was fish and chips which both smelled and looked extremely good. Service users who had the full lunch reported that this was the case. The soft and puree version of the lunch did not look so appetising. In the former case the staff member had to mash the peas up, and in the latter it was not possible to determine what food was on the plate. Where soft or puree diet is provided consideration must be given to the taste preferences of the service users, and to how the food is presented. This is Requirement 9. Although there is a dining table in the lounge on the first floor, plus separate dining rooms on the ground and first floor, only one service user appears to eat at a dining table, the remainder eating in their rooms, or off small tables in front of their lounge chairs. It is not clear if this is through choice This is commented on further under the Environmental Standards. The Cambridge Nursing and Residential Care Home G55_S0000037315_Cambridge NH_V231611_040605_Stage 4.doc Version 1.30 Page 15 The Cambridge Nursing and Residential Care Home G55_S0000037315_Cambridge NH_V231611_040605_Stage 4.doc Version 1.30 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Some service users and relatives do not always feel confident that their concerns and complaints will be listened to. EVIDENCE: Records of complaints held by the Commission were examined and service users, and some relatives were asked their views. Based on this the Commission is concerned that comments/complaints may not always be addressed promptly, and that potential complainants may feel uncomfortable in raising concerns. A well run home should welcome comments/complaints as a means to improve their service. Requirement 10 has been set so that the Registered Persons can consult service users, relatives and staff, and amend the complaints procedure as appropriate. The Cambridge Nursing and Residential Care Home G55_S0000037315_Cambridge NH_V231611_040605_Stage 4.doc Version 1.30 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21 23, 24 & 26 Service users live in a safe environment with access to comfortable indoor and outdoor communal facilities. There are sufficient suitable lavatories and washing facilities. The current allocation of bedrooms results in there being a mix of younger adults and older people on each floor, and this may not be in the best interest of the service users. EVIDENCE: The building was toured, accompanied by one of the Nursing Sisters, at the start of the first visit, and all three floors were visited unaccompanied later during the day. On the second visit the ground and first floors were toured, both accompanied and unaccompanied. Some bedrooms were seen either by invitation of the service users, or with their permission, whilst others were seen because the doors were open. All areas of the home were clean, tidy and free from odour during both visits. The Cambridge Nursing and Residential Care Home G55_S0000037315_Cambridge NH_V231611_040605_Stage 4.doc Version 1.30 Page 18 Despite there being some separate dining facilities most service users eat all meals on small tables sitting in lounge chairs. A Recommendation was set at the previous inspection that the registered providers review the use of all communal areas of the home in consultation with service users and staff. This has been restated and included as Requirement 11. The home provided information on current bed occupancy, and this denotes the ground floor (with 17 beds) being for younger physically disabled people, the first floor (with 23 beds) being for older people, and the top floor (with nine beds) for elderly mentally infirm i.e. Dementia. There are currently both younger adults and older people on each of the three floors. The Commission is concerned that this may not be in the best interest of either group. Several service users from both groups were noted to spend most of their time in their room, which could be very isolating. The service users who were observed to be in the lounges tended to be less able to articulate a preference. The allocation of space within the home has been discussed with the manager at previous inspections. Requirement 11 has been set so that a formal review, including consultation with service users and their representatives, is carried out in relation to the primary use of each floor. This is commented on further in the section on staffing. The Cambridge Nursing and Residential Care Home G55_S0000037315_Cambridge NH_V231611_040605_Stage 4.doc Version 1.30 Page 19 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29 The home employs sufficient staff to meet the needs of the service users, but the wide range of needs that the home is attempting to meet may mean that there is a skills shortfall. The home’s recruitment practice is currently robust, but the heavy reliance on the recruitment of nurses from overseas to work as carers whilst doing adaptation training may not be in the best interest of the service users. EVIDENCE: Health and personal care needs were discussed with some staff, and staff were observed carrying out their duties during both visits. Three staff files were examined, which were all for staff recruited since the last inspection. Service users and their relatives were asked their views, and were very complimentary about the staff, particularly the carers. The rota was examined during the first visit and when compared with the needs identified in the care plans there were sufficient numbers of staff on each shift to meet need. As stated earlier in the report the Commission is concerned that the home is attempting to meet a very wide range of needs. Staff would need to be extremely knowledgeable and experienced to meet all needs comprehensively. This was discussed with the manager, who reported that he believed that collectively the staff group did have the knowledge and skills to meet all the needs of current service users. Requirement 12 has been set so that the manager may demonstrate to the Commission that this is the case. The skills audit and training needs analysis will need to take account of all current needs i.e. care of older people, including nursing care; care of younger people with physical disabilities, including nursing care; care of people with functional mental health problems; The Cambridge Nursing and Residential Care Home G55_S0000037315_Cambridge NH_V231611_040605_Stage 4.doc Version 1.30 Page 20 care of people with learning disabilities; and care of people with age related physical and psychological problems, including nursing care. It will also need to take account of current UK standards of good practice in both nursing and social care, and government policy, such as Valuing People, for services for people with learning disabilities. The home has recruited six new staff since the last inspection in February 2005. All seven are nurses who trained overseas and are employed by the home as carers whilst they do adaptation training, which will then allow them to practice as nurses in this country. This requires the manager and the RGNs to both supervise their nursing practice and to assess them. The recruitment files of three of these members of staff were examined, and the Commission was pleased to note that they came from varied backgrounds, with one being a psychiatric nurse specialist which is needed in this home. In other cases the staff member’s experience was restricted to acute general hospital care, which is a completely different setting to a care home. The Commission is concerned about the home’s reliance on this method of recruitment for several reasons: The block recruitment of six new members of staff in a short timescale must have put pressure on the existing staff group, in particular the Sisters, who would have had responsibility for induction. It would also have introduced six new members of staff to the service users over a short period of time. Many of these service users need consistency, and because of communication problems need staff that know them well. The manager and RGNs must spend a considerable amount of time in supervising and assessing nursing practice. This is in addition to managing the home, and this could be to the detriment of the social care needs of the service users. Whilst these members of staff are well qualified they may not be immediately aware of health and social care policy and best practice in the UK, and this may mean that the nursing and personal care culture within the home does not match that expected by visiting professionals, or by the Commission. This point was discussed with the manager who gave the view that the past few months had been extremely difficult for all staff, due to continual visits by the PCT, Social Services, and the Commission. He stated that in his view the home needed a period of consolidation, in order that the care planning system could be fully implemented. Requirement 13 has been set so that the Registered Manager ensures that the staff skill mix, knowledge, and experience meets the needs of service users at all times. The Cambridge Nursing and Residential Care Home G55_S0000037315_Cambridge NH_V231611_040605_Stage 4.doc Version 1.30 Page 21 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 & 33 The Registered Manager does not have a system in place for measuring the quality of the service provided in the home. There is no record of the time that the Registered Manager spends working in or for the home. There is no conclusive evidence that the home is run in the best interests of the service users. EVIDENCE: Discussions were held with the Registered Manager and staff, and service users and their relatives were asked their views, along with records being checked. Over recent months several visiting professionals have raised concerns about the standards of care provided by the home, in particular the nursing care. In addition the PCT and Social Service reviews have highlighted concerns about The Cambridge Nursing and Residential Care Home G55_S0000037315_Cambridge NH_V231611_040605_Stage 4.doc Version 1.30 Page 22 the on going care of service users. This Commission inspection particularly focused on this during the two visits. Where so many concerns have been raised by a range of professionals the Commission would expect to see remedial action being taken by the Registered Manager and the owners of the home; in this case the Registered Manager is one of the two owners. There was no record of any checks or audits by the Registered Manager or the other owner on the standards of care. In discussion, the manager stated that he was in the process of developing a system. Refer to Requirements14 and 15 The Registered Manager’s times of working are not detailed on the rota. This was discussed with him at the end of the second visit when he reported that if he filled in his duty rota it would just be 9 to 5, but that would not mean that that was what he worked, as he may often be out of the building. This is Requirement 16. The Cambridge Nursing and Residential Care Home G55_S0000037315_Cambridge NH_V231611_040605_Stage 4.doc Version 1.30 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 2 3 3 x x 2 x 3 STAFFING Standard No Score 27 2 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x 2 2 2 x x x x x The Cambridge Nursing and Residential Care Home G55_S0000037315_Cambridge NH_V231611_040605_Stage 4.doc Version 1.30 Page 24 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 & YA1 Regulation 4&6 Requirement The Registered Providers must review the Statement of Purpose to ensure that it accurately reflects both the categories of service users whose needs can be met, and the regulatory body that registers the home. The Registered Persons must be able to demonstrate that the assessed needs of all service users are being met and that staff have the appropriate skills and training in demential care. Previous timescale of 31/01/05 not met The Registered Manager must be able to demonstrate that the assessed personal, health and social care needs of all service users are being met. This must include staff having appropriate experience and knowledge in the care of the full range of illnesses and disabilties that the current service users have, whether they are the primary reason for admission to the home or not. It is a Requirement that all handwritten entries on the Medication Administration Records (MAR) charts are signed Timescale for action 31/08/05 2. OP3, 7 & 8 & YA2, 3, 6 &7 12, 13 & 15 30/06/05 3. OP3, 7 & 8 & YA 2, 3, 6&7 12, 13 & 15 30/09/05 4. OP9 & YA20 13 (2) 31/07/05 The Cambridge Nursing and Residential Care Home G55_S0000037315_Cambridge NH_V231611_040605_Stage 4.doc Version 1.30 Page 25 5. OP9 & YA20 13 (2) 6. OP12 & YA11, 14 & 16 16 (2) (m) & (n) 7. OP15 & YA 15 16 (2) (i) 8. OP15 & YA15 16 (2) (i) and dated by the person making the entry. Previous timescales of 31/10/04 and 30/04/05 not met. The Registered Manager must address all Requirements identified by the Commissions Pharmacist Inspector on his visit on 3 June 2005. It is a requirement that service users are given opportunities for stimulation through leisure and recreational activities, in and outside the home, which suit their needs, preferences, and individual capacities. Particular consideration should be given to service users with dementia, cognitive and sensory impairment. Previous timescales of 31/01/05 and 31/05/05 not met. The Registered Manager must seek advice from a dietition as to appropriate menus for all meals. The food provided must constitute a balanced and varied menu that meets nutritional needs and individual preferences, including soft and puree food. A record of all special dietary requirements must be maintained in the kitchen e.g. diabetic, low salt, high protein, puree and soft. 31/08/05 31/07/05 31/08/05 31/07/05 9. 10. OP 16 & YA16 22 The Registered Manager must 31/09/05 review the working of the current complain procedure so as to maxiimise the chances of all service users and relatives using it. This must include identifying any blocks that they perceive to reporting concerns and complaints. The Registered Manager must 31/10/05 G55_S0000037315_Cambridge NH_V231611_040605_Stage 4.doc Version 1.30 Page 26 11. OP19 & 24, 23 The Cambridge Nursing and Residential Care Home & YA 23 & 24 12. OP27 & 29, & YA31, 32 & 33 18 13. OP27 & YA 33 18 14. OP31 & 33, & YA37 & 39 8 & 24 15. OP31 & 33, & YA37 & 39 8 & 24 16. OP31 & 32, & YA37 & 38 17 (2) & Schedule 4.7 review the use of both communal and individual space within the home, in consultation with the service users and their representatives. This must take account of the wide range of needs that the home is trying to meet. The Registered Manager must carry out a skills audit, and training needs analysis on all staff. From this a training and development programme must be developed so as to ensure that the wide range of needs of the service users can be comprehensively met. The Registered Manager must ensure that the staff skill mix and experience on each shift is appropriate to meet the needs of all service users. The Registered Persons must ensure that they carry out regular checks on the service being provided within the home. This must include suitable arrangements for monthly visits to be undertaken in compliance with Regulation 26 of the Care Homes Regulations 2001. The person carrying out this visit must prepare a report and supply a copy of the report to the Commission. Previous timescales of 30/11/04 and 30/04/05 not met. The Registered Persons must supply the Commission with a written account of how they intend to audit the quality of care provided within the home, so as to ensure that all service users needs are met. The Registered Manager must ensure that the duty rota includes a true and accurate record of his hours worked at the 30/09/05 31/08/05 31/07/05 31/07/05 31/07/05 The Cambridge Nursing and Residential Care Home G55_S0000037315_Cambridge NH_V231611_040605_Stage 4.doc Version 1.30 Page 27 home. 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 Good Practice Recommendations The Cambridge Nursing and Residential Care Home G55_S0000037315_Cambridge NH_V231611_040605_Stage 4.doc Version 1.30 Page 28 Commission for Social Care Inspection Ferguson House 113 Cranbrook Road Ilford Essex IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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