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Inspection on 25/02/08 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 25th February 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

What has improved since the last inspection?

Since the previous inspection plans of care that say how residents should be cared for have improved and begun to show that staff have talked to residents and their relatives when writing the plans. Staff now make sure that they follow the plans when checking residents` weights and they are writing down what they have done when someone is found to have lost weight. Parts of the home have been redecorated with new furniture, carpets and curtains. There was indication that some recreational activities had been provided to people living on the Linden Unit, however this still needs to be improved and increased.

What the care home could do better:

The manager should find out more about what people at Carders Court would like to eat and make sure that the effects of changes are made clear to people. The manager should make sure that all the units are clean and free from unpleasant odours. She should also make sure that fixtures, fittings and equipment that become worn out or broken are mended or replaced quickly. The manager should make sure that staff receive more in-depth dementia care training. This will help staff to communicate with and understand the needs of people with dementia. This is important because a large proportion of people living at Carders Court have some degree of short-term memory loss and/or dementia. The manager should provide CSCI with the copy of the responses made to the result of the Carders Court 2007 customer satisfaction survey.

CARE HOMES FOR OLDER PEOPLE Carders Court Nursing Home 23 Ivor Street Castleton Rochdale Lancashire OL11 3JA Lead Inspector Michelle Haller Unannounced Inspection 25th and 26th February 2008 10:00 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.V360261.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. Carders Court Nursing Home DS0000017322.V360261.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carders Court Nursing Home Address 23 Ivor Street Castleton Rochdale Lancashire OL11 3JA 01706 712377 01706 869391 bottrilc@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Ltd 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) Mrs Carol Ann Bottrill Care Home 150 Category(ies) of Dementia (150), Old age, not falling within any registration, with number other category (150), Physical disability (3) of places Carders Court Nursing Home DS0000017322.V360261.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing: Code N, to people of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category: Code OP (maximum number of places: 150); Dementia: Code DE (maximum number of places: 150); Physical disability: Code PD (maximum number of places: 3 of the following age range: Over 50 years of age). The maximum number of people who can be accommodated is: 150. 28 September 2006 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 and conservatory. 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 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. Fees charged by the home, provided in February 2008, are in the range of: £339.90 to £591.01. Additional charges are made for personal toiletries, hairdressing, chiropody and trips out. Carders Court Nursing Home DS0000017322.V360261.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was a key inspection that included an unannounced site visit to the home. The manager was not informed beforehand that we were coming to inspect. We looked at all the information that we have received, or asked for, since the last key inspection. The annual quality assurance assessment (AQAA) was returned. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Eight surveys were returned to us by people using the service and from other people with an interest in the service. Information we have about how the service has managed any complaints or allegations were examined. What the manager has told us about things that have happened in the service, these are called ‘notifications’ and are a legal requirement were taken into account. The inspection process also involved interviews with four people living at Carders Court and three relatives. The plans of care and other records about care for 11 people were also fully examined. Six members of staff were interviewed and in-depth discussions with the deputy manager were also conducted. In addition, information was also gained through the training and employment records for recent recruits that were read. A tour of the communal areas of the home was also undertaken and, during the course of the inspection, the interactions between people in the home were observed. The previous key inspection report was also read through. Carders Court Nursing Home DS0000017322.V360261.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Since the previous inspection plans of care that say how residents should be cared for have improved and begun to show that staff have talked to residents and their relatives when writing the plans. Staff now make sure that they follow the plans when checking residents’ weights and they are writing down what they have done when someone is found to have lost weight. Carders Court Nursing Home DS0000017322.V360261.R01.S.doc Version 5.2 Page 7 Parts of the home have been redecorated with new furniture, carpets and curtains. There was indication that some recreational activities had been provided to people living on the Linden Unit, however this still needs to be improved and increased. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Carders Court Nursing Home DS0000017322.V360261.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Carders Court Nursing Home DS0000017322.V360261.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 (standard 6 is not applicable) Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Prospective residents benefit from having their needs fully assessed. EVIDENCE: We (the commission) examined 11 care files in full. Detailed assessments were completed before people moved into Carders Court. Each file contained assessments and there was evidence through the written daily records and family participation records that the resident, their family and social workers had been involved. Carders Court Nursing Home DS0000017322.V360261.R01.S.doc Version 5.2 Page 10 Each assessment provided information about the person’s physical and emotional condition. The assessment uses a scoring system that acts as a trigger for a specialist assessment, depending on what the person scores in each area. The areas included health care needs, moving and handling, personal care, communication, personality and mental needs, personal care needs and diet. This system appeared to work well, as through case tracking the care for these 11 people it was possible to confirm that, in the majority of cases, relevant specialist assessments had been completed and care plans were in place. People who were interviewed also confirmed that in order to check that their relatives’ needs could be met, the manager or other qualified staff had completed an assessment before the person was accepted into the home. They said ‘The (manager and unit manager) came to (resident’s) home to assess her needs.’ And ‘(Clinical lead) came out and assessed her needs in the hospital and then she was admitted in a couple of days.’ A member of staff returned a CSCI survey and stated that people’s needs could be met because good assessments had been completed. People benefit from having their needs assessed before moving into a service because then the manager can be certain that the facilities and staff can meet their needs and routines. Carders Court Nursing Home DS0000017322.V360261.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Good health and physical comfort is promoted as people receive health and personal care based on their individual needs and people are usually treated with dignity and respect. EVIDENCE: Each care plan examined was individualised and centred on the person. A variety of specialist assessments and related interventions dealing with identified needs, including falls, moving and handling, tissue viability, continence, communication, medication and previous medical history, had been developed. These provided detailed and clear information to staff about the actions they were to take and the expected outcomes. Care plans had been reviewed, although attendance lists did not always show that the person had been involved. Carders Court Nursing Home DS0000017322.V360261.R01.S.doc Version 5.2 Page 12 Records and reports showed, and people said, that they had received health care check-ups, such as dental care, chiropodist, optician, flu injection and other medical check-ups. It was usually possible to see that care plans were updated and people received the correct treatment for urinary tract infections, chest infections, pressure area care, weight loss, diabetes care and other illness that developed. There were occasions, however, when there appeared to be an oversight in updating health care plans and risk assessments. This was discussed with the person in charge of the unit at the time of the inspection. People had good access to equipment and were seen using Zimmer frames and pressure relieving cushions; these were clean and well maintained. Wheelchairs all had footplates and staff had easy access to moving and handling equipment, such as belts and hoists. Moving and handling practice appeared safe during observations made on all the units over the two days of this inspection. The clinical manager stated that there were good links with the district nurses and other health professionals. Records, letters and other correspondence confirmed that people living on the different units had good access to specialist assessment and treatment. Observation of the interaction between staff and residents living on the different units at Carders Court indicated that most of the time people were treated with dignity and respect, and on no occasion was personal care carried out in communal areas. There were occasions on Linden Unit when people were not always approached with as much patience as expected, however, there were also examples of gentle, positive and caring interaction seen. People in all parts of the home were dressed according to their choice and were usually clean and well groomed. Although there have been some recent changes in the provision of toiletries, and this has caused some disappointment, people were positive about the health and personal care they received. People living at Carders Court said: ‘if you need a doctor they bring them straight away.’ ‘I’ve been well looked after - I’m encouraged to do what I can - I make my own bed in my own time - I’ve kept my own doctor.’ ‘I’ve had an injection to stop flu, been to the eye hospital it (health care) is quite satisfactory.’ Carders Court Nursing Home DS0000017322.V360261.R01.S.doc Version 5.2 Page 13 ‘They look after my health but I’ve not really needed anything special - had an eye test and injection.’ And: ‘I’ve had my eyes checked and new glasses for reading - our feet are done – all sorts!’ Some surveys stated that health care was ‘usually’ met and one person commented that they had waited for a dressing to be applied; however, no name was given. The accident and daily records examined at the time of the inspection indicated that wounds were dealt with as soon as they were discovered or brought to the attention of staff. Relatives who were spoken to were satisfied: ‘My wife has improved since she came here, personally I’m pleased with what’s gone on so far’. Daily records were examined and entries were respectful. There were examples of very detailed and person centred entries, there were also times when the reports lacked detail and did not show that the instructions in the care plans had been carried out. Also, they did always provide a picture of people’s daily life. These matters were discussed with the person assisting with the inspection process. The management of medication was assessed over two units. Staff who administered medication sign to confirm that they have read and understood the medication policy and guidance. A medication round was observed and no problems were identified at that time. There are photographs of each person on the corresponding medication administration record sheet (MARS) and no unexplained gaps were noted. Medication that was destroyed was also recorded on the MARS. The handling of controlled medication was also observed. The medication was correct. The registered person needs to make sure that the controlled medication cabinet meets current pharmaceutical guidelines. Otherwise there were no problems highlighted with medication administration. Carders Court Nursing Home DS0000017322.V360261.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. People living at Carders Court are able to enjoy a lifestyle of their choice; they are well nourished but feel that they would be more content if the quality and choice of food were improved. EVIDENCE: The majority of care plans included information about people’s past lives, experiences and interests. Files also contained information about preferences that included bedtime routines, diet, care staff and interests. There are three activities co-ordinators employed at Carders Court. Each one takes main responsibility for initiating and organising activities on specific units. BUPA has produced an activities handbook with ideas that can be used when developing the activities calendar. The activities programme on each unit varies in an attempt to meet the different interests and skills. Carders Court Nursing Home DS0000017322.V360261.R01.S.doc Version 5.2 Page 15 Activities included clothes parties, arts and crafts, board games, ball games, quizzes, jigsaws, walks out and cake making. The organisers also arrange for entertainers to the home. Outings have included visits to Blackpool, shopping at local malls, barge trips and meals out. The organisers keep a record of the activities that people have enjoyed, both in groups and individual sessions. These records showed that activities were varied enough to interest people with different abilities and not just a few of the people who were most able. Newspapers and books are provided and one person said that she was taken to the library. People were very satisfied with the activities in the home. Further more, on most of the units, care staff also took on the role of providing entertainment and spent time talking to people, getting to know them and supporting them in having a meaningful lifestyle. Although it was clear that activities on the dementia care unit need further development, people were encouraged to join in with music events and one to one interaction. The activities co-ordinator assigned to Linden is designing a 1940’s style living room that people may enjoy. The need to review the activities to reduce the risk of boredom and encourage positive interactions was discussed with the unit manager. This person had been in post for about nine weeks at the time of the inspection and she described some of the changes she had made so far and her future plans. The manager also stated in the AQAA that it was possible for staff to support people on whatever activity they chose, including time away on holiday. People were happy with the activities and entertainment available at Carders Court and people who returned surveys indicated that, in the main, activities either always or usually, met their needs. People who were spoken to said: ‘Have had sing-along concerts in the past six months which she enjoys and she enjoyed the Christmas do’s’; ‘I enjoy the trips out. In March I’m going to the Blue Planet Aquarium’; ‘I enjoy reading a lot, doing crossword and watch television - I don’t want to go down there and I’m not bothered about trips’; ‘I’m going to the Lowry centre for some shopping’ and ‘There’s enough to do at the moment, we play dominoes, bingo and I like the organised trips out.’ This aspect of care would be further improved if the activities people did were recorded in their daily records, because it is important that care staff have access to this information so that they can provide some continuity. It was reported that all staff complete an introduction to dementia care workbook. Observations of interactions during the inspection indicated that additional training might assist staff in developing better communication skills in relation to the varying needs of people with dementia. Carders Court Nursing Home DS0000017322.V360261.R01.S.doc Version 5.2 Page 16 We observed that people are able to have visitors as they please and receive visitors throughout the day. People were encouraged to maintain their relationships and spouses were encouraged to spend time in privacy. People said: ‘My daughter comes when she likes’, ‘People can visit when they like’ and ‘people can visit any time’. Observation and reports also confirmed that routines in the home were flexible. In the main, people were able to as they pleased and their choices were respected. In the main, staff were respectful and pleasant and referred to people by their preferred name or title, for example, ‘Mrs …’ instead of first name. A mealtime on the EMI unit was observed and the process was calm and people were supported with patience. Meal choice was flexible and people were offered an alternative if they did not want what was provided. The soft diet was presented in a partitioned plate so that foods could be kept separate; however, this did not look particularly appetising, as the colour of the food was beige. The meal choice for lunch was soup, beans on toast or sandwiches and rhubarb crumble and custard. People enjoyed the soup, with one person commenting, ‘They make lovely soup’. At teatime (16:45) the choice was beef stew and dumplings or spicy meat balls. Both meals seemed to be enjoyed and people were offered additional helpings and seemed content with these meals. ‘I’ve had a good dinner – I’ve enjoyed it.’ Others who were interviewed were generally content and said ‘the food is quite satisfactory - I’m not a faddy eater.’ ‘Food is average. It’s generally ok, there is variety from what I see and have sampled it from time to time 8 out of 10. No problems with quantity.’ In spite of this, some people voiced dissatisfaction with the food. People said that in the past they were offered a cooked breakfast and this had now stopped. They felt that a lot of sandwiches or ‘bread based’ meals were offered. The menu confirmed that this was the case. In addition to this, the main meal that is served between 16:45 and 17:00 (4:45pm and 5pm) was early, unless a substantial supper was also offered and this did not seem to happen routinely. Many people who were interviewed stated that their relatives brought in biscuits and snacks. People also said ‘I do not like the food’ and ‘There’s always something missing for breakfast’ and ‘The food is on and off’. Carders Court Nursing Home DS0000017322.V360261.R01.S.doc Version 5.2 Page 17 One person who returned the CSCI surveys said ‘I do not like all the pasta plus it’s cold and I don’t like curry, sardines on toast and kippers on toast and sandwiches are boring. No garnish and it’s the same every day.’ On the second day of the inspection the lunchtime choice was soup and sandwiches or pork barmcake - this meant that there was not really a choice because a barmcake is another type of ‘sandwich.’ The menu included: beans on toast, fishfingers, corned beef hash, hotdogs, meat in barmcake and chips, desserts such as crumbles, sponges, scones and ice cream were also served. Yoghurts were also on offer. The ‘evening’ meals included beef stews, fish in sauce, cauliflower cheese and other meat, fish and vegetable dishes. People said that they were offered drinks and biscuits later in the evening and one person said the staff would give her hot milk when she wanted it during the night. Fresh fruit was freely available on each unit. The person assisting with the inspection stated that there was a supper menu that people could choose from. However, it was unclear whether this was always offered. She agreed to make sure that people were routinely offered the substantial snacks that were available on the ‘night bite’ menu. Weight charts showed that people usually put on weight when they moved into Carders Court and significant weight losses were usually investigated and appropriately managed. Carders Court Nursing Home DS0000017322.V360261.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 good. This judgement has been made using available evidence, including a visit to this service. People benefit from an environment where they can express their concerns, have access to a complaint procedure and are protected from abuse. EVIDENCE: People we spoke to and the majority of those who returned surveys said that they knew how to make a complaint and felt that their concerns would be listened to and dealt with fairly. People said ‘staff will listen’. We looked at the complaints record and complaints from each unit were logged in when received, the type of complaint was also recorded and the response that was made. Complaints had been responded to in writing and it was clear that the person making the complaint was also involved in the investigation. The home’s Protection for Vulnerable Adult guidelines and policy provides staff with a guide about behaviours and omissions that are abuse. Staff training records identified that all new staff received instruction through direct training, the use of videos and workbooks in the protection of vulnerable adults. Carders Court Nursing Home DS0000017322.V360261.R01.S.doc Version 5.2 Page 19 Staff who were interviewed were clear about behaviours that could be considered abuse and were keen to state that if they had any worries, they would approach the manager or social services if they were unhappy with the response. They said: ‘Yes, I have received POVA training and this helped me to identify things that seemed normal that could be abuse, like calling people ‘love’ and we have to say to people what we are doing and offer our help to people who can make a choice’ and ‘We have to make sure what we say and do is ok for the person, for example, to touch people to comfort them.’ The manager had dealt with three safeguarding investigations in the past year and the correct action was taken to protect people living in the home. Carders Court Nursing Home DS0000017322.V360261.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence. including a visit to this service. The physical environment on the majority of units at Carders Court appears safe, generally well maintained and comfortable. It is important that this is the case throughout the home, so that everyone lives in clean and pleasant accommodation. EVIDENCE: Carders Court is set out in five 30 bedded units. The grounds and gardens are very well maintained and inviting. A tour of all the units was completed and this included all the communal areas of the home, a number of bedrooms and the laundry. Carders Court Nursing Home DS0000017322.V360261.R01.S.doc Version 5.2 Page 21 The majority of areas in the home were clean and a refurbishment programme is in place. Recently, the corridor carpet, sitting area and dining areas of Linden and Rakeswood have been replaced. People were observed accessing the different areas of the home independently using specialist equipment that had been provided, such as electric wheelchairs, Zimmer frames and walking sticks. Bathroom and toilet doors, in some units, were labelled with pictures that would assist with recognition. These were, in the main, clean, warm and fitted with appropriate aids and adaptations, such as handrails and specialist baths. A memory box was in the bedrooms of some people, and each bedroom that was entered was clean and warm. Specialist equipment, such as rise and fall beds were in place. Rooms had been personalised to suit the individual and people said that they were able to choose their own décor. Good practice posters were on display in the toilet and bathroom areas. The floors and walls of the laundry are washable. The washing machine used is from a specialist firm and provided ‘sanitise’ and ‘sluice’ wash programmes. The sluicing facilities at Carders Court are not very satisfactory. The only taps for rinsing soiled commode linings are over small hand-washing sinks and the sterilising machine on one unit is broken. It is important that the manager makes sure that equipment is available to promote effective infection control. Although most units were clean and free from unpleasant odours, Brookfield Unit had a very strong smell of urine at the entrance. The dining-chairs on a number of units also require cleaning, as these were soiled, sticky and unpleasant to use. This was discussed with the person assisting with the inspection. Also the laminate flooring in one bedroom is in very poor condition and this should be dealt with, so that everyone at Carders Court has sound flooring that is easy to clean and pleasant to look at. Overall, people who returned CSCI surveys indicated that though some areas needed refurbishment, the home was usually clean and fresh. People said ‘The place is clean and I’ve nothing to grumble at’. Carders Court Nursing Home DS0000017322.V360261.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 good. This judgement has been made using available evidence including a visit to this service. People at Carders Court benefit from staff who are employed using a safe recruitment process, who receive training and who are generally provided in sufficient numbers to support the smooth running of the home. EVIDENCE: Each unit has a senior member of staff responsible for running the unit. The training co-ordinator was interviewed and she said that she had good links with both the local health trust and local authority training units. She also stated that BUPA provides courses. Trainers include suitably qualified BUPA staff and specialist training organisations. The training co-ordinator described the induction process for new recruits. Each person completes an intensive six-week induction that involves direct teaching, filling in workbooks on different topics, videos and practical training. The topics covered during induction include fire safety, safe moving and handling practice, led by a qualified moving and handling facilitator, protection of vulnerable adults, basic infection control and food hygiene. The workbooks include an assessment and exam at the end of each section. Carders Court Nursing Home DS0000017322.V360261.R01.S.doc Version 5.2 Page 23 Records and calendars indicated that staff training provided since the previous inspection has included: fire safety, in-house POVA training, infection control, manual handling, control of substances hazardous to health (COSHH), safe use of bedrails, basic food hygiene, record keeping and care planning. The training record also identified that 35 care staff have attained National Vocational Qualifications (NVQ) in Care level 2 or above and 17 staff have been enrolled onto the course. BUPA has also introduced a staff development scheme called ‘Personal Best’ which encourages staff to develop good practice. A significant number of people living at Carders Court have a dementia and so the manager should provide more intensive training courses in dementia care. Staff who returned CSCI surveys stated that they received enough training to do their jobs well. Those who were interviewed were pleased with the amount of training offered at Carders Court. Relatives were also aware of the training available and felt that staff had the necessary skills to do their jobs. Comments included: ‘I have recently become a senior and I’ve had achieved NVQ level 2 and will enrol onto the level 3 course, manual handling course, and I got the same medication training as the unit manager - we went to Rochdale council training unit. I go on all the training possible – there’s a rolling programme’ and ‘The staff are encouraged to undertake NVQ’s but do not know how many hold them, they are not displayed’; ‘I feel they are trying to keep abreast of all the legislation, I feel they are very keen to keep up corporate image.’ Four staff files were examined and each contained a copy of the completed application form, two references, additional proof of identity, a photograph and all POVA first checks had been completed. The recently recruited maintenance person’s Criminal Record Bureau (CRB) check had not been received, however the POVA first had been returned. The importance of monitoring the progress of the CRB application was highlighted and it was agreed that this would be made a priority. Carders Court Nursing Home DS0000017322.V360261.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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People at Carders Court benefit from management and administration that is open and respectful, and quality assurance systems have been established. EVIDENCE: The registered manager was not available during the time of this key inspection; however, the clinical lead or deputy for Carders Court was present and also the manager from another BUPA care home made herself available. The manager has achieved CSCI Registered Manager status and is a registered nurse. Carders Court Nursing Home DS0000017322.V360261.R01.S.doc Version 5.2 Page 25 The AQAA that the manager submitted was clear and identified areas of strengths and also where the service could improve. Some of the information was related to Carders Court and gave a good picture of how the home was run and about future plans. Formal supervision for all staff has been introduced. This was not examined in depth because discussion with staff and observations did not raise any major concerns in this area. People involved in the home expressed mixed views about some aspects of the management of the home. People identified that some services at Carders Court had been reduced. For example, ‘Initially all toiletries were provided - I now have to provide them.’ There was a sense that these changes would be ongoing and this was to do with ‘BUPA corporate’ decisions. However, people were satisfied with the direct manager and staff. Comments included: ‘I can’t praise them enough for what they have done.’ The manager co-operates fully with the CSCI. She demonstrates her openness through informing us of all incidents in the home that have had or may have a serious detrimental effect on the residents or on the running of the home. Finances for people at Carders Court are managed through a system that records and keeps receipts for all transactions. There is running total in an accounting computer programme. These are audited by BUPA area office. The manager stated in the AQAA that there are a number of strategies in place to assist with Quality Assurance monitoring including, ‘… minuted residents and relative meetings.’ These were not looked at as the home had just received the results of its annual audit and questionnaire that provided information about what people thought about the facilities. This information will be shared with all involved. We would like to be provided with a copy of the action plan or other responses made as result of this 2007 Customer Satisfaction Survey. Health and safety at Carders Court appeared well managed. Date stickers on equipment and information in the AQAA confirmed that equipment and services were maintained, serviced and monitored in keeping with the relevant guidance. According to the training records, health and safety related training including infection control, food hygiene and moving and handling training is provided. Carders Court Nursing Home DS0000017322.V360261.R01.S.doc Version 5.2 Page 26 The registered provider has completed monthly quality assurance visits (Regulation 26) and, as a part of this, reported that the fire logs and checks were complete and up-to-date. Carders Court Nursing Home DS0000017322.V360261.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Carders Court Nursing Home DS0000017322.V360261.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action Carders Court Nursing Home DS0000017322.V360261.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 Good Practice Recommendations The registered person should make sure that a variety of activities are made available to people living on Linden House to make sure that the residents do not become bored and to give them a continued interest in life. This may reduce the risk of developing repetitive or challenging behaviour and promote a sense of wellbeing and belonging. The registered person should make sure that all parts of the home are clean and free from unpleasant smells. They should also make sure that broken or damaged furniture, fixtures and equipment are replaced quickly. This is so that people always live in a clean and pleasant environment and so that staff have the equipment available for them to do their jobs properly. The registered person should make sure that staff receive training in specialist areas so that residents benefit from staff who carry out their jobs using the most up to date communication and behaviour management techniques. The registered person should make sure that more people are satisfied with the food provided at Carders Court. This is so that people have a sense of wellbeing and emotional satisfaction after they have eaten or as they look forward to the next meal. The registered person should develop a system to highlight when Criminal Record Bureau checks that have been applied for have been returned. This is so that people working in the home are fully vetted as soon as possible during the induction period. This is because POVA First checks are only one part of the safeguarding adults vetting process. 2 OP26 3 OP27 4 OP15 5 OP29 Carders Court Nursing Home DS0000017322.V360261.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Manchester Local Office Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Carders Court Nursing Home DS0000017322.V360261.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. 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