Inspection on 13/06/05 for Cassandra House

This inspection was carried out on 13th 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

Cassandra House 18/03/08

Cassandra House 13/07/06

Cassandra House 26/10/05

Cassandra House 31/01/05

Cassandra House 23/08/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Cassandra House 19 Dunswell Lane Cottingham East Yorkshire HU16 4JA Lead Inspector Pam Dimishky Unannounced 13 June 2005 at 9:30 am th 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. Cassandra House J53_s19656_Cassandra House_v225597_130605_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cassandra House Address 19 Dunswell Lane Cottingham East Yorkshire HU15 4JA 01482 876150 01482 876111 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) Carol Lesley Olive Murrey Carol Lesley Olive Murrey Care Home 42 Category(ies) of OP Old Age (42) registration, with number DE(E) Dementia (42) of places Cassandra House J53_s19656_Cassandra House_v225597_130605_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st January 2005 Brief Description of the Service: Cassandra House is a care home situated in the semi-rural area of Cottingham. The home is a detached Tudor style property built in 1910 with a modern extension. The home is set in quiet surroundings with enclosed courtyard complete with tables and chairs for residents to utilise. Accommodation within the home consists of both single and double bedrooms, some with ensuite facilities. Communal living space consists of five lounges, dining room and a conservatory. Cassandra House is a family run business and is one of two care homes owned and managed by the family. The care home provides personal care and is registered for 42 elderly people aged 65 or over, some of whom may have dementia. Cassandra House J53_s19656_Cassandra House_v225597_130605_Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over seven hours (including preparation). The inspection process included a review of documentation and a tour of the building. The inspector spoke to eleven of the thirty-eight residents, the provider/manager, administrator and two members of staff. What the service does well: What has improved since the last inspection? Many of the requirements made at the last inspection have been actioned. Some improvements have been made in keeping daily records of the care delivered to meet the care plan, but there is still room for further improvements. Medication records previously a concern, were seen at this inspection to be accurate and in order. One of the lounges has been redecorated and there are plans for new carpets and redecoration of corridors. A new hairdressers room is being created on the ground floor which will be an improvement on the one used at present. Cassandra House J53_s19656_Cassandra House_v225597_130605_Stage 4.doc Version 1.30 Page 6 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. Cassandra House J53_s19656_Cassandra House_v225597_130605_Stage 4.doc Version 1.30 Page 7 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 Cassandra House J53_s19656_Cassandra House_v225597_130605_Stage 4.doc Version 1.30 Page 8 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) 1,3 and 6 Some information is available for prospective residents to make an informed choice about where to live. However this does not include all the information required. Prospective residents needs are assessed before entering the home to ensure the needs can be met by the home. EVIDENCE: Two residents recently admitted to the home said they had no information prior to coming into the home. However, it transpired the arrangements were made as an emergency over the bank holiday, and the manager confirmed the statement of purpose and service user guide were provided when they came into the home and copies also given to the family. Since the last inspection the documents have been amended, but some information is still outstanding ie the number, qualifications and experience of staff, the number and size of rooms and the arrangements for respecting privacy and dignity. A copy of the statement of purpose and service user guide are kept in the entrance to the home and are available to residents and visitors. Cassandra House J53_s19656_Cassandra House_v225597_130605_Stage 4.doc Version 1.30 Page 9 A pre-admission assessment and assessment on entering the home ensures needs can be met. Copies of these assessments are evident in the care plan. The home is not registered for intermediate care. Cassandra House J53_s19656_Cassandra House_v225597_130605_Stage 4.doc Version 1.30 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 standard(s) 7,9 and 10 Residents care plans have sufficient detail to provided staff with the information they need to satisfactorily meet residents assessed needs. The systems for administration of medications are good ensuring residents medication needs are met. Residents and staff were able to demonstrate residents are treated with respect and their privacy is upheld. EVIDENCE: Eleven residents said they were well cared for and the staff are very good. Staff appeared relaxed and were observed having appropriate interaction with residents. Three care plans were seen to include all the information needed for staff to meet assessed needs. Risk assessments were in place for handling and for the environment. One resident is using bed rails and a risk assessment was included in the case file for their use. An input/output chart for some residents is being kept up to date. All three care plans had been reviewed monthly. Daily records have improved since the last inspection but further care is needed in recording sufficient detail to illustrate the care plan is being met. One care plan had four days (three of them consecutive) during the last month where a daily record had not been made. Cassandra House J53_s19656_Cassandra House_v225597_130605_Stage 4.doc Version 1.30 Page 11 Medications are stored in two purpose made drug cabinets, including for controlled drugs. A monitored dosage system is being used and three cassettes and medicine administration records were checked and in order. Privacy curtains are in use in shared rooms and there was no evidence at this inspection that residents do not have their own clothing returned from the laundry. Staff interviewed were able to demonstrate how they respect the privacy and dignity of residents. A couple in the home for respite care also confirmed their right to privacy was being upheld. Cassandra House J53_s19656_Cassandra House_v225597_130605_Stage 4.doc Version 1.30 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 standard(s) 12,13,14,15 Daily life and social activities meet the expectations and choice of the residents living in the home. The lives of residents are enriched by family and friends being able to visit the home and maintain telephone contact. The meals in the home are good offering choice and variety according to the wishes of the residents. EVIDENCE: A conversation was held with eleven residents individually who all expressed their satisfaction with the home. Other residents were observed indirectly and the interaction between themselves and care staff appeared relaxed and entirely appropriate. Residents interested in gardening belong the home’s gardening club and arrangements are in hand for residents to pot up the flower tubs for the inner courtyard. Other activities taking place in the home include arts and craft three days a week, sing songs, reminiscence, manicure and video days. One resident stated she was self caring and staff confirmed they encourage residents, as far as possible, to be independent. A visitors book in the entrance to the home indicated the home has plenty of visitors. Residents confirmed they are able to have visitors at any reasonable time. A cordless telephone is available to make and receive telephone calls and a number of residents have their own telephone installed in their room. Staff stated the weekly bath chart had been compiled according to choices made by the residents and during conversation, residents were able to Cassandra House J53_s19656_Cassandra House_v225597_130605_Stage 4.doc Version 1.30 Page 13 demonstrate the choices they make in daily living, eg bathing times and frequencies, getting up and going to bed according to choice, when and where to eat, alternatives to the main menu are displayed in the dining room and always available. On the day of inspection, the menu for lunch consisted of sausage plait, roast potatoes and beans, rice pudding or fruit and ice cream. Cassandra House J53_s19656_Cassandra House_v225597_130605_Stage 4.doc Version 1.30 Page 14 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 and 18 The home has a satisfactory complaints system and there is evidence that residents views are listened to and acted upon. Vulnerable adults policies, procedures and staff training ensure that residents are protected from abuse. EVIDENCE: Two complaints have been recorded since the last inspection and action has been taken to the satisfaction of the complainants. Senior staff have attended training for the protection of vulnerable adults and this is cascaded to other care staff. The policies and procedures manual is given to all new staff as part of their induction and the manual is kept readily available at all times. Cassandra House J53_s19656_Cassandra House_v225597_130605_Stage 4.doc Version 1.30 Page 15 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) 19,25 and 26 Whilst there is an ongoing programme of maintenance and redecoration, there is a need for some improvements in the home (some of which are planned) to provide residents with an attractive, homely and safe place to live. EVIDENCE: The programme for providing radiator covers in the home is nearing completion. The hairdressing room has been re-located to the ground floor and is almost ready for use. The hot water to the shower head was running in excess of 43 degrees C but the room is not yet in use. The manager confirmed she would check that a thermostatic valve has been fitted as the plumber was expected to call the day of the inspection. (Two days following the inspection, the administrator stated the plumber had not visited but confirmed the room is not complete and therefore is still not in use). The small lounge in the extension has been newly decorated and looked clean and pleasant. There is a need for redecoration of corridors which is programmed to take place along with new carpets. Cassandra House J53_s19656_Cassandra House_v225597_130605_Stage 4.doc Version 1.30 Page 16 Despite the best efforts of the home, four bedrooms had an offensive odour and one of these rooms should have the bed replaced. One resident is using oxygen and does not have an “oxygen in use” sign displayed on the door. The kitchen was not inspected on this occasion as the environmental health officer had visited shortly before this inspection; the report dated 7th June 2005 made no requirements. The inner courtyard looked very pretty with a large bed of begonias. The gardening club is to pot up the flower beds which will also add to the area making it a pleasant place for the residents to while away their time. Cassandra House J53_s19656_Cassandra House_v225597_130605_Stage 4.doc Version 1.30 Page 17 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 and 30 Sufficient staff are deployed at all times to meet the needs of the residents. An ongoing training programme ensures staff are trained and competent to do their jobs. EVIDENCE: Thirty-eight residents presently living in the home are cared for by seven staff, including one working in the office, on the early shift, four on the late shift and three at night. The training programme indicated some mandatory training is outstanding but this is ongoing. Staff interviewed demonstrated they are also receiving specialist training, eg dementia care, pressure care, management of incontinence and care of the dying. Twelve members of staff are currently taking NVQ level II and seven staff have qualified at either NVQ level II or III. Cassandra House J53_s19656_Cassandra House_v225597_130605_Stage 4.doc Version 1.30 Page 18 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) 31,33,35 and 38 The manager has a good understanding of the areas in which the home needs to improve. Arrangements were in place as to how these improvements will be resourced and managed. EVIDENCE: The manager has been in post since the home opened in 1991 and is co-owner of the business. She is registering to take the Registered Managers Award and will verify whether her City and Guilds qualification in care is equivalent to NVQ level IV. Meetings with relatives are being held approximately six monthly and the next meeting was advertised for 10th July 2005. The home has parts I and II of the local authority quality development scheme and annual audits are made of the services provided. Cassandra House J53_s19656_Cassandra House_v225597_130605_Stage 4.doc Version 1.30 Page 19 A bank account has been set up in the name of Mellandine client account and records are being kept of monies received and of expenditure eg chiropody and hairdressing. Bank charges are being paid by the home’s business account and any interest will remain in the clients account. The account is not being independently audited. The fire officer visited the home on 11th May 2005 and has highlighted a number of deficiencies. The manager stated she has discussed these and agreed with the fire officer to complete the work within twelve months. Fire alarm and emergency lighting checks have not been made since May 2005. Fire training takes place six monthly and is scheduled for eighteen staff during August 2005. Sixteen staff have qualified in first aid and someone so qualified is available on each shift. Some health and safety training, including food hygiene and manual handling is outstanding. A health and safety poster is displayed in the office used by staff. Cassandra House J53_s19656_Cassandra House_v225597_130605_Stage 4.doc Version 1.30 Page 20 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 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 x x x x x 1 1 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 x 2 x 3 x x x Cassandra House J53_s19656_Cassandra House_v225597_130605_Stage 4.doc Version 1.30 Page 21 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 1 Regulation 4,5,6 Requirement The statement of purpose and service user guide must be amended as detailed in the body of this report Complete the programme of ensuring radiators have a low temperature surface or are guarded Ensure the hot water outlet to the hower in the hairdressers room is maintained at a temperatujre no greater than 43 degrees C A programme for redecoration including corridors must be implemented Where oxygen is in use in the home an oxygen in use sign must be displayed Undertake an audit of beds and replace as necessary The home must be kept free of offensive odours Ensure all staff receive training and updates for health and safety, manual handling, fire safety, food hygiene, first aid and infection control Ensure weekly checks are made for the fire alarm and emergency J53_s19656_Cassandra House_v225597_130605_Stage 4.doc Timescale for action 31.7.05 2. 19 13,23 31.12.05 3. 19 13,23 On receipt of this report 31.3.06 On receipt of this report Ongoing On receipt of this report On going 4. 5. 6. 7. 8. 19 25 26 26 38 23 13,23 16 13,16 13 9. 38 23 On receipt of this Page 22 Cassandra House Version 1.30 lighting 10. 38 23 Ensure the work needed to rectify the deficiencies identified by the fire officer is completed within the agreed timescale report 30.4.06 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. 2. 3. 4. 5. Refer to Standard 7 19 31 33 35 Good Practice Recommendations A daily record should be made indicating in sufficient detail how the care plan is being met A bathing policy should be displayed in bathrooms, hairdressing room and shower rooms for good prqactice in ensuring residents are protected from the risk of scalding The manager should have an NVQ level IV in management and care, or equivalent by 31.12.05 The policy for health and food safety needs reviewing To ensure residents financial interests are safeguarded, the Mellandine clients account should be independently audited Cassandra House J53_s19656_Cassandra House_v225597_130605_Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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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