Inspection on 26/10/05 for Cassandra House

This inspection was carried out on 26th October 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cassandra House 18/03/08

Cassandra House 13/07/06

Cassandra House 13/06/05

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 Hull East Riding Of Yorks HU16 4JA Lead Inspector Pam Dimishky Unannounced Inspection 26th October 2005 09:15 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 Cassandra House DS0000019656.V260310.R01.S.doc Version 5.0 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. Cassandra House DS0000019656.V260310.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Cassandra House Address 19 Dunswell Lane Cottingham Hull East Riding Of Yorks HU16 4JA 01482 876150 01482 876111 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) Carol Lesley Olive Murrey Carol Lesley Olive Murrey Care Home 42 Category(ies) of Dementia - over 65 years of age (42), Old age, registration, with number not falling within any other category (42) of places Cassandra House DS0000019656.V260310.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th June 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 en suite 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 DS0000019656.V260310.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over 8.50 hours (including preparation). The inspection process included a review of documentation and a tour of the building. The inspector spoke to nine of the forty residents, two relatives, the provider/manager, administrator and two members of staff. Residents were also indirectly observed in the dining room and three lounges. What the service does well: What has improved since the last inspection? Many of the requirements made at the last inspection have been actioned or are still being progressed. Daily records being made by staff to evidence the care provided in meeting the care plan has improved since the last inspection. The hall, stairs and corridors look very nice since having new carpet laid and redecoration has also taken place in these areas. The home has an ongoing programme for refurbishment and redecoration of the home and evidence was seen of this being implemented. A new hairdresser’s room on the ground floor, which is more beneficial to residents, is now operational. However, due to the hot water being delivered at a too high temperature, arrangements were made for the hairdresser to use a ground floor bathroom until the plumber could make the necessary adjustments. The responsibility for arranging activities taking place in the home has now been given to one of the senior carers and this is proving to be very successful both with residents and for team building with staff. A recent trip to Bridlington (in a coach especially adapted to take wheelchairs) included a fish and chip lunch and was totally Cassandra House DS0000019656.V260310.R01.S.doc Version 5.0 Page 6 paid for as a result of funds raised through the summer fete which was also a huge success; some relatives joined the party and also assisted staff. A DVD player and two stereo players have also been purchased through the funds raised for the residents. A Christmas tree with lights is to be installed in the inner courtyard of the home and staff are currently arranging a Christmas lights switching on party for residents, their family and friends. Improvements have been made in managing odours attributed to incontinence. 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 DS0000019656.V260310.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Cassandra House DS0000019656.V260310.R01.S.doc Version 5.0 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 the following standard(s): 1,3 and 6 Prospective residents have the information they need to make a decision as to whether to come into the home. The admission procedure includes an assessment being made of residents moving into the service to ensure the home can meet their needs. EVIDENCE: On pre-admission a copy of the statement of purpose and service user guide is given to the prospective resident and/or their family. When visiting the home to view a copy of the statement of purpose is provided and the manager or senior member of staff undertake pre-assessments before the resident enters the home. Copies of the statement of purpose and service user guide are displayed in the entrance hall. Intermediate care is not provided in this home. Cassandra House DS0000019656.V260310.R01.S.doc Version 5.0 Page 9 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): 7,8,9 and 10 Residents care plans have sufficient detail to provide staff with the information they need to satisfactorily meet their assessed needs. However, for one resident with special needs, these were not included in the care plan. The health needs of residents are being met, with evidence of good multidisciplinary working taking place on a regular basis. EVIDENCE: Four care plans were examined and were seen to include risk assessments and evidence they are reviewed monthly. Daily records from staff on each shift are being recorded and key workers are making regular notes. One resident with special needs had no mention of these in the care plan or how the needs would be managed; there was also no evidence in the daily notes these needs are being met although the resident appeared well cared for and was happy about being in the home and the care received. All the residents spoken to expressed their satisfaction with the home and the care delivered. Staff appeared relaxed in carrying out their duties, and were observed having appropriate interaction with residents. Five residents medications and the administration records were checked and generally found to be in order. However, one resident’s drug, which is being Cassandra House DS0000019656.V260310.R01.S.doc Version 5.0 Page 10 stored and recorded as a controlled drug, could not be reconciled with the records, ie one tablet was missing. The provider/manager said she would investigate how this has happened. Health service professionals are providing support and advice to the home, eg general practitioners, district nurse, community psychiatric nurse, continence nurse, dentist, optician, chiropodist. Privacy curtains are installed in shared rooms and staff interviewed were able to demonstrate how they respect the privacy and dignity of the residents. Cassandra House DS0000019656.V260310.R01.S.doc Version 5.0 Page 11 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): 12,13,14 and 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, maintain telephone contact and from being able to participate in the special events taking place. EVIDENCE: Residents appeared to be happy with the daily routines and activities taking place in the home. One lady said she is able to care for herself with the support of staff and she can get up and go to bed when she wants. Although the home has a bathing rota compiled according to the residents’ individual preferences, residents did say they can have a bath when they want within reason, and staff also confirmed in interview that this is the case. The responsibility for activities taking place in the home has now been given to one of the senior carers and this is proving to be very successful both with residents and staff. A summer fete with stalls, organised by staff and supported by residents’ family and friends, was a big success. Money raised was sufficient to pay for a trip to Bridlington, including a fish and chip lunch, in a coach especially adapted to take wheelchairs; relatives joined the party and were able to assist staff. Photographs displayed in the hall record the day and relatives have been invited to have a copy if they wish. A DVD player and two Cassandra House DS0000019656.V260310.R01.S.doc Version 5.0 Page 12 stereo players have also been purchased through the funds raised for the residents. A Christmas tree with lights is to be installed in the inner courtyard and staff are currently arranging a “Christmas lights switching on party” for residents, their family and friends. The day following the inspection the home was having a “pink day” and staff, residents and visitors were being asked to wear pink. Arrangements are being made to celebrate Halloween and during the afternoon of the inspection, residents were busy making mobiles, to hang around the home, in the arts and crafts session which is held twice a week. During the summer months the home has a Gardening Club, which enables those residents interested in the subject to participate in small gardening projects. Evidence of their efforts can be seen in the inner courtyard where tubs still display the flowers they planted up. The visitors’ book in the entrance to the home indicated the home has plenty of visitors and residents confirmed they are able to have visitors at any reasonable time. A cordless telephone is available for residents to make and receive telephone calls, the home has two lines, and three residents have had their own telephone installed in their room. Some rooms have telephone points and families are able to make the arrangements for telephone installation if they wish. Quarterly resident/relative meetings are held and families and friends are invited to attend special events run by the home. The home operates a four-week menu rota and on the day of the inspection the menu board indicated lunch was mince and onion gravy, new potatoes, carrot and swede followed by spotted dick and custard or fruit with cream or yoghurt. Standard alternatives, which are always available, are displayed around the menu board and staff and residents stated these are often requested. The manager stated an annual food audit takes place and residents are invited to suggest ideas which can be incorporated in the menus. Cassandra House DS0000019656.V260310.R01.S.doc Version 5.0 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): 16,17 and 18 The home has a satisfactory complaints system and there is evidence that residents’ views are listened to and acted upon. Arrangements for voting indicate residents legal rights are protected. Vulnerable adults policies, procedures and staff training ensure that residents are protected from abuse. EVIDENCE: No complaints have been recorded since the last inspection, but previous entries indicate the action taken to satisfactorily resolve the concerns. Senior staff have attended training for the protection of vulnerable adults and the manager stated this has been cascaded verbally to all staff individually. Staff interviewed said the subject had been covered as part of their NVQ, and that they had seen the home’s policy and procedures. When asked, they were able to demonstrate their knowledge of the different types of abuse and the action they would take should they be aware of abuse taking place in the home. The manager stated arrangements are made for residents wishing to vote, to have a postal vote or if they prefer to visit a polling station, this can also be arranged; leaflets from the different parties are made available in the lounges. Cassandra House DS0000019656.V260310.R01.S.doc Version 5.0 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): 19,22,25 and 26 The standard of the environment within this home is generally good providing residents with an attractive, clean and homely place to live although some chairs in the lounge were not seen to be clean. EVIDENCE: The location and layout of the home is suitable for its stated purpose. It is accessible and well maintained with an ongoing programme for refurbishment and decoration. Since the last inspection new carpet has been laid in the hall, corridors and stairs making the areas look very attractive; redecoration has also taken place. The carpet square in the hall has not got a ramp edge and therefore may present as a trip hazard. Some chairs in the lounges were seen to be soiled and may need recovering or replacing. The manager stated plans are being made for the chairs to be replaced with ones covered with a material which can be sponged down. The hairdresser’s room has now been relocated to the ground floor, but the hot water to the showerhead and the wash-hand basin, which is also used with a shower, had hot water being delivered at a high temperature. (This was Cassandra House DS0000019656.V260310.R01.S.doc Version 5.0 Page 15 identified at the previous inspection and a requirement made for the water to be delivered at no more than 43 degrees C). The plumber was contacted on the day of the inspection and the inspector was informed, by the administrator the following day, that the plumber would be attending on 31/10/05. Arrangements have been made in the interim for the hairdresser to see her clients in the downstairs bathroom and the hairdresser’s room is being kept locked. One bedroom had the bed head placed alongside the radiator, which is not of low surface temperature or guarded. The manager covered the radiator with a bed rail cover to prevent harm and stated she would ensure the radiator would be next on the list for having a guard installed. The seat of the toilet next to the laundry has worn and the home cannot be certain it is being thoroughly cleaned. Terry towels are being used to dry hands in toilet areas as, in the past, paper towels have been put down toilets resulting in them being blocked. The manager stated the towels are changed routinely four times a day and as necessary. Two bedrooms, which despite the best efforts of the home, still had a slight odour; this is an improvement on previous inspections. The inner courtyard looked attractive with tubs and beds, planted by residents belonging the Gardening Club, still in flower. The kitchen was not inspected on this occasion as an inspection had been made by the environmental health officer earlier in the year and the report, dated 7th June, 2005, made no requirements. Cassandra House DS0000019656.V260310.R01.S.doc Version 5.0 Page 16 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): 27,29 and 30 Sufficient staff are deployed at all times to meet the needs of the residents. After a period of some instability in staffing there is now a good match of staff offering consistency of care within the home. Current recruitment practice is sufficient to ensure residents are protected from abuse. An ongoing training programme is ensuring staff are competent to do their jobs. EVIDENCE: Forty residents are currently living in the home and are being cared for by four staff on the early and late shifts, plus one senior carer and one senior carer working in the office and three staff at night. A new member of staff is currently working under supervision as part of her induction and until clearance is given from the Criminal Records Bureau. An ongoing training programme for the year, includes moving and handling, food hygiene, medications, pressure care and fire safety. The continence nurse is providing training at the end of this month and pressure care awareness is on the programme for November; arrangements are also in hand for staff to be given a second fire safety lecture. Progress is being made in 50 of care staff being trained to NVQ level II, eight staff already having either level II or III and a further eight staff due to complete the qualification at level II by the end of December. Cassandra House DS0000019656.V260310.R01.S.doc Version 5.0 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): 31,33,35,37 and 38 The home is being well managed and there is leadership, guidance and direction given to staff to ensure residents receive consistent quality care. However, more effort should be made by the manager in completing the qualifications to meet the national minimum standards. Record keeping policies and procedures are in place but there is a shortfall in some legally required records being sent to the Commission on time. The home regularly carries out maintenance checks pertinent to the health and safety of residents and staff. EVIDENCE: The manager has been in post since the home opened in 1991 and is she is coowner of the business. She stated she will not be able to complete the Registered Managers Award and NVQ level IV in care before 31/12/05 to comply with the national minimum standards and is not able to forecast when these qualifications will be obtained. The home has parts I and II of the local authority quality development scheme and annual audits are made of the home. Residents and their relatives are Cassandra House DS0000019656.V260310.R01.S.doc Version 5.0 Page 18 able to influence the services provided through meetings arranged by the home throughout the year; a senior carer is now in charge of organising the meetings. A bank account has been set up for residents (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 manager stated the account will be independently audited, along with the home’s accounts, at the end of the year. Fire drills are taking place weekly and fire alarms and emergency lighting are being checked as part of the exercise. Fire extinguishers were checked during June 2005 and arrangements are being made for staff to receive their second fire safety lecture this year. Certificates were seen dated 9/05/05 and 14/06/05 for the lift and six hoists six monthly thorough examination, the landlords gas safety certificate is dated 7/05/05 and the employers public liability certificate displayed in the office is current to January 2006. One resident had been using a trolley style chair, and two accidents had been recorded as a result of being transported down the ramp in one of the corridors. A risk assessment has been made for using this chair and only a wheelchair will be used in future. Two recent accidents in the home involving a visit to the Accident and Emergency unit had not been reported to the Commission for Social Care Inspection as required. Cassandra House DS0000019656.V260310.R01.S.doc Version 5.0 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 3 x 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 1 x x 3 x x 1 1 STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x 1 3 Cassandra House DS0000019656.V260310.R01.S.doc Version 5.0 Page 20 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. 1 Standard OP7 Regulation 15 Requirement Ensure residents care plans include all areas to meet their assessed needs and that the plan is kept under review Ensure drugs are able to be reconciled with the drug administration records at all times Complete the programme of ensuring radiators have a low surface temperature or are guarded Ensure hot water outlets in the hairdresser’s room are thermostatically controlled to deliver water at no more than 43 degrees C Furniture in the lounges must be kept clean and the soiled chairs be replaced or recovered All notifications required by regulation must be sent to the Commission without delay Ensure the work already commenced to rectify the deficiencies identified by the Fire Officer is completed within the agreed timescale Timescale for action 26/10/05 2 OP9 13 26/10/05 3 OP19 13,23 28/02/06 4 OP25 13 31/10/05 5 6 7 OP26 OP37 OP38 23 17 23 31/12/05 26/10/05 30/04/06 Cassandra House DS0000019656.V260310.R01.S.doc Version 5.0 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. 2. 3. 4. 5. 6 Refer to Standard OP19 OP19 OP31 OP33 OP35 OP30 Good Practice Recommendations The new carpet in the hall would benefit from having a ramped edge to prevent causing trips and falls A bathing policy should be displayed in bathrooms, hairdressing room and shower rooms for good practice 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 Mellandene clients account should be independently audited The home should ensure 50 of care staff are trained to NVQ level II or equivalent by 31/12/05 Cassandra House DS0000019656.V260310.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Hessle Area Office First Floor, 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. Extracts may not be used or reproduced without the express permission of CSCI Cassandra House DS0000019656.V260310.R01.S.doc Version 5.0 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!