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Inspection on 22/03/06 for Carders Court Nursing Home

Also see our care home review for Carders Court Nursing Home for more information

This inspection was carried out on 22nd March 2006.

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.

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

What the care home does well

Residents and relatives considered they were well cared for at Carders Court. One person said `the care is good, they look after you and go out of their way for you.` The building and grounds were clean and well looked after. Staff and residents said that if anything needed fixing, it was done quickly and rooms were decorated when needed. Comments from a relative were "the staff are superb", "I have every confidence in them", "they keep me informed of any changes and how my sister is progressing".

What has improved since the last inspection?

The manager has now successfully registered with the Commission for Social Care Inspection. The home has arranged a contract with a firm that is registered to dispose of unwanted medication.

What the care home could do better:

Plans of care that say how residents should be cared for need further improvement and must show that staff have talked to residents and their relatives when writing the plans. This is still not happening and the manager said she would make sure that steps are taken steps to address the problem. Staff must make sure they follow the plans when checking residents` weights and writing down what they have done when someone is found to have lost weight. A record of what residents eat and drink needs writing down. The nursing staff on one Unit had not taken action when it was found that a resident was losing weight therefore putting the resident at further risk. There were not enough staff to look after the residents and therefore a letter of serious concern was sent the owners, for allowing this to happen, as well as asking the home to put more staff on the Unit immediately. Enough staff must be working at all times so that residents know they can have the help they need.

CARE HOMES FOR OLDER PEOPLE Carders Court Nursing Home 23 Ivor Street Castleton Rochdale Lancashire OL11 3JA Lead Inspector Bernard Tracey Unannounced Inspection 22nd March 2006 09:30 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 Carders Court Nursing Home DS0000017322.V268838.R01.S.doc Version 5.1 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. Carders Court Nursing Home DS0000017322.V268838.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Carders Court Nursing Home Address 23 Ivor Street Castleton Rochdale Lancashire OL11 3JA 01706 712377 01706 869391 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) www.bupa.com BUPA Care Homes (CFHCare) Limited Care Home 150 Category(ies) of Past or present alcohol dependence (1), registration, with number Dementia (1), Dementia - over 65 years of age of places (60), Old age, not falling within any other category (90), Physical disability (2) Carders Court Nursing Home DS0000017322.V268838.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 150 service users to include:Linden House - up to 30 service users in the category of DE (E) (Dementia over 65 years), for nursing care; and up to 1 Adult with Dementia (DE). Rakewood House - up to 30 service users in the category of OP (Old People over 65 years), for nursing care; to include up to 2 service users in the category of PD (Physical disability under 65 years), but to be aged between 50 and 65. Brookfield House - up to 30 service users in the category of DE (E) (Dementia over 65 years). Arkwright House - up to 30 service users in the category of OP (Older People over 65 years). Garfield House - up to 30 service users in the category of OP (Older People over 65 years); to include up to 1 named service user in the category of A (past alcohol dependence - the registration should revert back when this person leaves or becomes 65 years of age. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 28th November 2005 2. Date of last inspection Brief Description of the Service: Carders Court Care Home is situated on the outskirts of Castleton town centre close to shops and other amenities and is near to the main bus route. Carders Court consists of five separate units each providing care to meet the differing needs of the residents. Two units provide care for residents with a dementia (Linden and Brookfield House), two provide personal general care (Arkwright and Garfield) and one unit (Rakewood) provides general nursing care. Each unit has 30 beds, and all personal accommodation is provided in single rooms that are on the ground floor. The communal areas on each unit comprise a lounge, dining area, conservatory and a smoking area. Garden and patio areas surround each unit. There is a central administrative block that contains the main office, kitchen and laundry areas and a hairdressing salon. Ample parking areas are provided for visitors and staff. Carders Court Nursing Home DS0000017322.V268838.R01.S.doc Version 5.1 Page 5 Carders Court provides care for 150 people, male or female, generally over the age of 65 years. Care can be provided for an agreed number of young adults, who are aged between 50 and 65 years of age, who have physical disabilities. The registered provider is Care First Health Care Ltd. owned by BUPA. Carders Court Nursing Home DS0000017322.V268838.R01.S.doc Version 5.1 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken by the Lead Inspector for the home and took place over five hours on the 22nd March 2006. This is the second inspection for the year and should be read together with the first inspection carried out on 28th November 2005 to give an overview of all the standards assessed within this period. Observations were made of the care provided and four residents talked about their personal experiences of life for them in the home. Four members of the nursing and care staff, the manager, general manger the administrator and the handyman, as well as two relatives, were spoken with during the course of the inspection. The inspector looked at the care records and at satisfaction questionnaires which asked what people thought of the care and services provided by the home. A detailed inspection of the maintenance records was made and all of the safety records were examined. What the service does well: What has improved since the last inspection? The manager has now successfully registered with the Commission for Social Care Inspection. The home has arranged a contract with a firm that is registered to dispose of unwanted medication. Carders Court Nursing Home DS0000017322.V268838.R01.S.doc Version 5.1 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Carders Court Nursing Home DS0000017322.V268838.R01.S.doc Version 5.1 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 Carders Court Nursing Home DS0000017322.V268838.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The key standards were examined at the last inspection Assessment of individual need is made before each resident moves into the home to ensure that the home can provide the care needed by the individual. EVIDENCE: The key standards were examined at the last inspection on the 28th November 2005. All of the key standards were met. Carders Court Nursing Home DS0000017322.V268838.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 789 The health care needs of some residents were not being met. Staff must be more vigilant in monitoring the weight of the residents and ensure that appropriate action is taken when residents have lost weight. The home is not consistently good at involving residents or their representative in the development or review of care plans. The ordering and administration of medication as well as the disposal of unused medication is well managed. EVIDENCE: At the last inspection of the home the records of one resident indicated a marked fluctuation in the weight of the individual but no evidence of an intervention by the staff to investigate the cause. A discussion with the unit manager suggested that the scales needed re-calibrating and an undertaking was made to ensure that this was done without delay. The home stated that the scales had been examined and were now calibrated. A review of the monitoring of residents’ weight was undertaken at this inspection. One resident had a nutritional care plan in place that required her to be weighed and any weight loss was to be reported. A significant weight loss of 8kg was recorded on the 2nd March 2006 but incongruously an entry Carders Court Nursing Home DS0000017322.V268838.R01.S.doc Version 5.1 Page 11 stating “slight improvement” had been made against this record despite the clear evidence that the resident had lost weight. There was no entry in the care plan to refer the resident to her GP and to involve the dietician. It would also be expected that given there was a significant loss such as this the resident should have been monitored and weighed weekly. The details of the omissions were immediately relayed to the Unit Manager and later to the Registered Manager and General Manager at feed back. The Registered Manager agreed to undertake a complete review of all the residents’ nutritional assessments and weight records. It was also stressed that the actual date of weight recording was made and not, as is the practice, the month. A letter of serious concern was sent to the Registered Provider following the inspection. At the last inspection it was found that not all units provided written evidence of residents or their representatives being involved in the drawing up and review of individual care plans. Although the home undertook to ensure that residents and their relatives were involved in the drawing up and review of the care, with written evidence that this was occurring, there has been no progress. The medications system was safe. Medications were securely stored; the prescription administration sheets were filled in accurately and there was an accurate record of medicines received into the home with arrangements in place for the safe disposal of unused medicines from the two nursing units. Designated and appropriately trained staff administered medicines. Carders Court Nursing Home DS0000017322.V268838.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The key standards were examined at the last inspection Social activities are well managed, creative and provide daily variation and interest for people living in the home. Visiting arrangements at the home are informal and family and friends of residents are encouraged to maintain contact therefore maintaining and promoting personal relationships. A nutritious, varied and balanced diet was provided and enjoyed by residents. EVIDENCE: The key standards were examined at the last inspection on the 28th November 2005. All of the key standards were met. Carders Court Nursing Home DS0000017322.V268838.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The key standards were examined at the last inspection The complaints process in this home was good and residents and their relatives were confident any concerns would be dealt with. EVIDENCE: The key standards were examined at the last inspection on the 28th November 2005. All of the key standards were met. Carders Court Nursing Home DS0000017322.V268838.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The key standards were examined at the last inspection The home has a planned maintenance and renewal programme for the redecoration and refurbishment of the home to ensure residents live in a comfortable, homely and safe environment. EVIDENCE: The key standards were examined at the last inspection on the 28th November 2005. All of the key standards were met. Carders Court Nursing Home DS0000017322.V268838.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 Inadequate staffing levels are placing residents at potential risk. EVIDENCE: From interviewing residents, staff and relatives, it was identified that the current staffing levels on Linden Unit were not meeting the needs of the residents. Normal staffing levels for the 30 residents were 2 nurses and 5 care assistants from 08.00 – 14.30 and 2 nurses and 4 carers from 14.30 to 21.00. Residents, relatives and staff spoken to said there were never enough staff on duty and other comments included “staff do their best”, “they’re very hard working” and “staff are over-stretched”. Two relatives confirmed this. Residents did however, speak well of the staff team and one relative said “the young carers are working above and beyond what can be expected”. Problems were particularly highlighted on the morning of the inspection on Linden Unit. The staffing on this day was 3 nurses and two care assistants, that is at least two carers short of what can be expected as a minimum. Of the two care assistants one was a recent recruit who had no previous experience of caring and it was his first day at the home, whilst the other care assistant had worked at the home for three weeks only. Although both carers were seen to approach their duties in a caring and sensitive manner, they could not reasonably be expected to be able to meet the needs of the residents with individual knowledge of their care needs. Carders Court Nursing Home DS0000017322.V268838.R01.S.doc Version 5.1 Page 16 As a result of the low staffing levels on this unit breakfast was still being served at 11.20 a.m. with several residents seen to be waiting for assistance with feeding. One resident said that he was having his “first cup of tea of the morning” at 10.50 a.m. The 8.00 a.m. medicine administration round was still in process at 11.30 a.m. and although the nurse was not at fault with this, the residents’ should be receiving their medication reasonably within the time prescribed by the G.P. In order to ensure the needs of the current resident group are met, the manager must undertake a thorough staffing review and ensure that staffing levels meet the assessed needs of the residents. An Immediate Requirement was made to increase the staffing levels on this Unit followed by a letter to the Responsible Person requesting written details of how they were intending to meet the identified shortfalls. Carders Court Nursing Home DS0000017322.V268838.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38 The home regularly reviews aspects of its performance through self-review and consultation, which included seeking the views of residents, staff and relatives. The health, safety and welfare of residents is promoted through safe working practices and the training of staff. EVIDENCE: Mrs. Susan Haigh has been employed to manage the home. An application to be the Registered Manager with the Commission for Social Care Inspection has now been successfully completed. She is a registered nurse with vast experience in private and NHS services. She had experience in community, hospital, residential and educational services. It is her intention to complete the Registered Manager Award. Carders Court Nursing Home DS0000017322.V268838.R01.S.doc Version 5.1 Page 18 The home did not act as appointee for any residents. However, they did manage the personal allowances of a number of residents. A discussion with the administrator in relation to how the home managed the finance indicated that a safe and audited system operates. Banked monies were held in a pooled residents account. Whilst in-house records showed the total amount held for each resident, bank statements did not provide this detail. The home had an accredited quality assurance system. Feedback is sought from the residents and relatives through a system of satisfaction questionnaires. A selection of these questionnaires was examined during the inspection and in the main was found to be complimentary. A yearly summary is produced and made available to residents relatives and visitors. The home’s handyman, who is supported in his role by the corporate estate manager, takes responsibility for maintenance and safety checks. Evidence was seen that indicated that fire extinguishers, alarms, lifts and hoists are all serviced and maintained as required. The Portable Appliance Test had been undertaken. A current certificate of inspection was available for the electrical and gas supplies to the home. Carders Court Nursing Home DS0000017322.V268838.R01.S.doc Version 5.1 Page 19 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 1 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X X Carders Court Nursing Home DS0000017322.V268838.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The registered person must ensure residents or their representative are involved in the review and development of the plan of care. Outstanding requirement in the timescale of 30/01/06 All residents are to have a care plan that sets out in detail the action which needs to be taken by the care staff to ensure that all aspects of the health personal and social care needs of the individual are met. The Registered Person must ensure that an accurate record of residents’ weights is maintained and appropriate action taken. Outstanding requirement in the timescale of 30/01/06 Staffing levels within the home must be reviewed and increased to ensure the needs of the current resident group are being met. Timescale for action 30/05/06 2. OP7 15 30/05/06 3. OP8 14 22/03/06 4. OP27 18 22/03/06 Carders Court Nursing Home DS0000017322.V268838.R01.S.doc Version 5.1 Page 21 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 OP8 Good Practice Recommendations The actual date, not the month that the resident is weighed, is recorded. Carders Court Nursing Home DS0000017322.V268838.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Carders Court Nursing Home DS0000017322.V268838.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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