Inspection on 26/01/07 for Catchpole Court Residential And Nursing Home

This inspection was carried out on 26th January 2007.

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

Catchpole Court Residential And... 13/08/08

Catchpole Court Residential And... 18/05/07

Catchpole Court Residential And... 26/06/06

Catchpole Court Residential And... 10/02/06

Catchpole Court Residential And... 02/08/05

Catchpole Court Residential And... 13/04/05

Catchpole Court Residential And... 18/08/04

Catchpole Court Residential And... 13/05/04

Catchpole Court Residential And... 20/02/04

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

CARE HOMES FOR OLDER PEOPLE Catchpole Court Residential And Nursing Home Walnut Tree Lane Sudbury Suffolk CO10 6BD Lead Inspector Mary Jeffries Unannounced Inspection 26th January 2007 10:40 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 Catchpole Court Residential And Nursing Home DS0000024351.V328726.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. Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Catchpole Court Residential And Nursing Home Address Walnut Tree Lane Sudbury Suffolk CO10 6BD 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) 01787 882023 01787 378836 catchpole.court@craegmoor.co.uk Speciality Care (REIT Homes) Limited Post Vacant Care Home 66 Category(ies) of Dementia (37), Old age, not falling within any registration, with number other category (29) of places Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th October 2006 Brief Description of the Service: Catchpole Court Residential and Nursing Home was built and first registered in 1991. Its current owners, Craegmoor Healthcare trading as Speciality Care (REIT homes) Limited, acquired the home in 1998. The home is located opposite to the Walnut Tree Hospital within a short distance of the centre of the small Suffolk town of Sudbury. The home is a large modern red brick building that is divided into two separate houses and can accommodate up to 66 residents. Constable House accommodates up to 29 physically frail older persons and Gainsborough House accommodates up to 37 older persons with a diagnosis of dementia. The home is built upon two floors with a shaft lift provided for access. Communal lounges, dining areas and conservatories are available for the use of the residents. Good car parking facilities are available for visitors. Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection. This unannounced inspection was carried out by two inspectors during one day in January 2007, and took seven hours. Two random inspections have taken place since the last key inspection, which occurred on 26th June 2006. These took place on 19th October 2006 and on December 18th 2006. Prior to the inspection of 18th December 2006, pre inspection surveys were sent to relatives, and 15 letters were sent to professionals known to be in contact with the home. Forty of the pre inspection surveys sent to relatives were returned to the CSCI. Thirty-five of these arrived on or before the day of the December inspection. Two General Practitioners, only, responded to the professionals survey prior to the inspection of the 18th December. A further response from a local Community Health Team has subsequently been received. Prior to this inspection, a staff survey was sent to the home. Only eight were returned. At this inspection, in addition to an inspection of key standards, the requirements identified at the random inspection of 18th December and which the home had been required to meet prior to the 26th January 2007, were followed up. Four residents were tracked, including one who had been admitted since the last random inspection. One resident was spoken with in some depth, another more briefly. Residents were spoken with and were observed at different times throughout the day. The inspection focused on residents in Gainsborough, the unit where residents with dementia live. The acting manager facilitated the inspection, care staff and nursing staff participated. There were 27 residents in Constable Wing with 2 vacancies. On Gainsborough there were 29 residents and one resident in hospital. There were 7 vacancies. This is a nominal figure as room 35 used to be used as a double but is not any longer, and one empty double room was being used as a storeroom. Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Standards of cleanliness have improved significantly in the home since the last key inspection. They have been seen to improve gradually over the course of the last two inspections, and at this inspection the home had reached an acceptable standard. Care planning had improved considerably since the first key inspection, and thorough reviews had taken place. The monitoring and responding to weight loss was identified as a requirement at the previous key inspection, records inspected indicated that this is now being well monitored and managed. The keypad lock found at the entrance and exit of the frail elderly unit at the last key inspection had been removed. The practice of restraining residents with dementia with lap belts whilst they were in chairs, and without full records of this, has ceased. Only one resident was identified as being restrained in this way at the random inspection in October, and there were appropriate supporting records in place. The home asked to further consider other methods of managing the risk of a person with dementia rising and falling, and this had been conducted prior to the December random inspection. Incontinence pads have been found to be stored discretely in residents’ rooms at this, and the previous, inspection. Décor and furnishing within the home has improved, although some required work is ongoing. The home has improved lighting in several residents’ rooms that were overshadowed by neighbouring trees. Financial transactions on behalf of service users had been witnessed by two members of staff. Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 7 What they could do better: The home must operate within its categories of registration. The home must have an accurate and up to date Statement of Purpose that complies fully with regulations. Residents must receive an up to date Service User Guide that complies fully with regulations, and includes a details of the complaints procedure, including timescales of response. The home lacks a stable management structure; there has been no registered manager since August 2004. Whilst there has been evidence of some improvements, this has yet to be seen to be sustained. The evidence suggests that whilst some care can be good, it is variable. Care records must include a full record of tilts and turns for residents who are mainly restricted to bed and who require this intervention. The home must ensure that service users are treated with respect at all times and that their wishes are respected. The individual rooms of residents who are in hospital must not be used for other purposes. The home must have a policy on death and dying which addresses the procedures following death. A full record of complaints, including details of investigation and any action taken must be maintained in the home. Repairs must be made to furniture and fittings in bedrooms on Gainsborough. Staffing levels must be maintained so that call bells can be answered promptly and residents with dementia are not left for periods unattended. The home must reduce its reliance on agency staff, and provide evidence of appropriate training of staff in the care of residents with dementia, and managing challenging behaviour. Staffs’ proficiency in English must be assessed and monitored. Staff must receive regular formal supervision, in line with regulations and national minimum standards. Interest must be paid on residents personal monies accounts held by the company, in accordance with their draft policy. Health and safety standards must be improved and a safe environment maintained. Adequate storage space must be provided, and stairwells must be keep clear and not used as storage areas such that they presents a heath and safety hazard to residents. Vacant rooms cannot be considered available for placement whilst these contain stored equipment. The home must comply with the requirements of the fire officer. Hot water outlets must be maintained at or around 43 degrees Celsius. The door to a hot water tank within a resident’s room must be kept locked in accordance with the written instruction. Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 8 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. Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 9 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 Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 10 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): 1,2,3,4,6, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst residents can expect to have been assessed prior to admission to the home, they will not, currently, have all of the information they require to make an informed choice. EVIDENCE: There was a Perspex holder in each room for the Service Users’ Guide. This document was found to be in place in one resident’s room, however, it was not current. The home was able to produce a draft copy of an updated Statement of Purpose. This was awaiting approval by the company. However it was pointed out to the manager that it described the 37 beds in Gainsborough as for the “elderly mentally infirm”. This should read “dementia”. The home is not registered to admit people with any form of mental disorder. Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 11 The Statement of Purpose contained all the items specified in the Regulations bar one. There was no information on the number and size of rooms. The Service Users’ Guide had recently been reprinted and copies were boxed up in the office awaiting the insertion of the revised Statement of Purpose. The Guide contained a copy of the Service User Agreement which details the fees payable and by whom they are payable. It identifies the Registered Manager as Vicki Hemsworth. Registration of this acting manager has not yet been applied for and therefore the document is misleading. The guide contains an example of the Terms and Conditions of Residency. This sets out what residents may, or more often may not, do. It has a very prohibitive style and contains no counter-balancing obligations of the provider. From September 1st 2006, providers must also include in their Service Users’ Guide a statement indicating whether charges or arrangements are different for people who have all or part of their care funded by somebody else. This was not included. The Service User Guide also contained a copy of the Complaints procedure, a sample lunch menu, and the Whistle blowing policy for staff. The complaints policy did not include a timescale within which complaints would be dealt with. The Service User Guide did not contain the most recent inspection report as specified in Regulation 5. In addition, NMS 1.2 also recommends the inclusion of a description of the individual accommodation and communal space provided, and residents’ views of the home. All four care plans inspected contained pre admission assessments, and included clinical diagnosis of the residents. The mouth care risk assessment had not been completed for the resident who was admitted twelve days prior to the inspection. This was discussed with the nurse on duty who advised that the resident had their own teeth, and that this not a priority need for them. A personal hygiene care plan had been completed, and a continence care plan had been completed. Following the first key inspection, which took place in June 2006, the manager of the home (at that time) was written to and advised they must apply for a variation to the conditions of registration. Documentation received from them had indicated that there were 41 service users with dementia, whilst he home was only registered for 37 residents with dementia. An application was received, but it was incomplete, and despite this being followed up by the CSCI this has not been returned. It remains unclear whether this is an issue. On Constable there were 4 residents who had recently been transferred from Gainsborough as their need for nursing care was of greater importance than their dementia. All were bed-bound. Given the number of vacancies on Gainsborough, the home was operating within its number of places registered, Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 12 although not all those with dementia were accommodated on special needs unit. One resident on Gainsborough had been admitted in 2005 at the age of 59. This resident did not fall within the home’s registration. The acting manager confirmed that one resident had a diagnosis of bi-polar disorder. A nurse on Gainsborough advised that one other resident on that unit had a history of mental health problems, but not a mental illness. (Personality Disorder). The home is therefore operating outside of its categories of registration. The acting manager confirmed that the home does not provide intermediate care. Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 13 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): 7,8,9,10,11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect staff to have a good understanding of their physical needs and to be referred for specialist medical interventions when appropriate, however residents with dementia cannot be assured that the home can always meet their needs adequately. EVIDENCE: The local Community Health Team advised in their feed back that that they have received a large number of referrals from Catchpole Court for residents with dementia who have challenging behaviours, which they considered should have been adequately managed by staff. They reported that in a number of cases clients had been admitted to the psychiatric wing of St. Leonard’s Hospital because the home had been unable to manage them, yet, the team advised, the clients settled within a few days of admission. They expressed the view that this suggests nursing approaches and environmental factors have influenced the person’s behaviour at Catchpole Court. At this time, only one resident residing on Gainsborough unit was being cared for in the hospital. Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 14 Since the last key inspection a Clinical Governance Support Manager employed by Craegmoor had been attending to assist the home improve practice. They participated in the random unannounced inspection in December 2006, and advised that were aware that dementia was not well care planned. They also advised that they had undertaken a full audit and devised an action plan for the home, which was under on going review, and that they had also focused on fluid charts and nutritional needs. The nurses on duty were asked which of the residents on Gainsborough had particularly challenging behaviour. One explained that is different ways all 29, explaining that as well as dementia they had “mental illness and physical health needs.” This was queried and the nurses advised that there was one resident, currently in hospital with a psychiatric diagnosis, and one other who had had long term involvement with mental health services. No disturbances or undue distress was witnessed on the Gainsborough on this occasion. Two nurses advised confirmed that this was that this was a “good day”; one nurse noted, “You should have been here the day before yesterday.” They confirmed that behaviour management plans were in place, but advised that quite often there was no recognisable precedent for the residents’ challenging behaviour. They did speak appropriately and knowledgably about their responses to challenging behaviour, for example one spoke of validating the residents’ feelings expressed rather than the content when the resident was distressed. A member of staff spoken with expressed the view that they considered the CSCI reports subjective and the local hospital to have a great knack of reporting concerns, which if investigated properly wouldn’t find anything. The local Community Health Team’s written response included the statement, “ Our visits are rarely logged by staff in charge and this makes it difficult for any advice to be formally implemented and followed up at a later visit.” They also commented that “We endeavour to support the staff at Catchpole Court with any difficulties they have been experiencing with clients with dementia. Some staff have been responsive to our suggestions and advice, and others, unfortunately, have not. Care recommendations and implementations have not always been consistent, and we have had to intervene when this could have been prevented through appropriate and consistent approaches from all members of nursing staff.” They also advised in their written comments that, “At times we have felt that some clients that have come to our ward should not be returned to Catchpole Court for their own protection as they have been labelled as “difficult”.” The team advised that in some cases Catchpole Court had been unwilling to accept residents back into the home after a hospital admission to St Leonard’s. One resident’s care plan that was inspected noted that they had demonstrated aggressive behaviour towards other residents. Two staff were asked what methods they employed to manage this. They advised that they monitor the residents’ mood, provide distractions, and ensure they are not sitting next to Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 15 another resident who they are known not to get on with. This resident had a mood chart on file, and a note that they are often found in other resident’s rooms. The resident’s care plan stated that the resident normally slept all through the night, and the nurse advised that hourly room checks were also made. All care plans inspected were comprehensive, fully reviewed, and well recorded. The records inspected contained either a profile or pen picture of the residents. One of the resident’s plans recorded a bruise to the face. This was recorded on a diagram, and reviewed within 48 hours. Another had a small bruise on the hip, which was similarly recorded and reviewed. There was evidence of a number of good risk assessments on the residents’ plans, including Waterlow pressure area risk assessments, falls risks assessments, moving and handling risk assessments and brief nutritional assessments. Some had more in depth nutritional assessments. These risk assessments were seen to have been reviewed on a monthly basis. Three of the residents had bedsides in use, all of which had a risk assessment. Residents also had assessments of their ability to use their call bells. One resident who was in bed on the day of the inspection, was heard calling out for assistance. The inspectors found that their care bell was not in reach, although they were assessed as being able to use it. A nurse advised that this was a mistake, and that the resident did not normally spend all day in bed. They put the bell in reach. Later in the day the inspector went to check whether this was still in reach, but found that the resident had responded to staff encouragement to get up and have something to eat. The resident was able to express that they found it hard to motivate them self at times, to get up and to eat. This was as staff had explained. This resident had a good nutritional risk assessment on file. Their care plan showed that they had lost 4 kilogram in weight at the beginning of November 2006, that weekly weighing had been instigated and that this was reported to the General Practitioner, in accordance with care planning, when they were found to have lost a further 4 kilograms. A medical review was held at the beginning of January. Another resident who was being weighed monthly and who had been identified as being at risk of malnutrition had a “nutritional support folder”; their weight had increased significantly over the last three months. They were diabetic and required assistance with feeding. Records of regular blood glucose tests were on file. The records of two residents who were on bed rest were inspected and these were both found to have chart records of turns/tilts occurring. These entries did not include which side the resident was turned on to. In one case, the resident’s relative confirmed that they it had been agreed for the resident to tilt towards them, during the daytime, as they spent each day with the resident in the home. This was confirmed on the care plan that identified the resident as being at high risk of developing pressure sores. The resident had Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 16 an air float mattress in place. The relative was able to use the rise and fall bed, which had an elevating backrest to assist their relative with food and drink during the day. The residents turn chart for the previous night only showed one turn, although records showed several changes of incontinence pads at night. This resident also had a fluid chart, which had been completed at regular intervals on the morning of the inspection, and on the previous day. They had a pureed diet; this had been recommended by the speech and language therapist who had seen the resident on account of swallowing difficulties. The residents’ care records also showed that a chiropodist had recently attended them. The relatives’ questionnaires received prior to the December random inspection indicated that some good care was experienced by residents. Relatives/friends were asked, “Are you satisfied with the care your relative receives.” 87.5 indicated that they were. One respondent stated, “the home does far more well than not well.” Other positive comments received included; “I have been impressed with the care (….….) has received during this time (last two months). (……….)’s key workers are great. One relative did not reply to this query, and three were not satisfied. One noted that this varied, and stated “depends which staff are on duty.” One of those who was dissatisfied commented “Lifting techniques poor when lifting out of chairs, pulling/dragging residents when walking with them”. The survey sent to professionals enquired whether they had any concerns about moving and handling. The return provided by the local Community Health Team, received prior to this inspection stated, “ Catchpole Court has a number of hoists which we believe are used appropriately.” No comments were included concerning moving residents from chairs. Four relatives who provided feed back prior to the December random inspection had indicated that residents’ clothing and personal hygiene were not consistently satisfactory. One had commented, “75 of the time appearance is acceptable but a lot depends on which staff are on duty.” Residents were observed closely on both the random and this key unannounced inspection and dress and personal hygiene was found to be satisfactory. Residents’ nails and hair was clean, and they were reasonable and individually dressed, although two residents observed in the lounge on Gainsborough in the morning had no shoes on. A member of staff advised that one of these residents did not like wearing shoes, and the other did not want them on that day. Positive comments received included, “They keep (………) fresh and clean. There have been many occasions when other visitors have commented how good (………) looks”. One of the residents tracked had a risk assessment for self-medication on file. The lunchtime medication round on Gainsborough, undertaken by the Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 17 Registered Nurse was observed. The correct procedure was followed to check that the correct medication and dosage was administered. The drug trolley was locked after each visit. No gaps in signatures were observed from a sample of MAR (Medicine Administration Record) sheets inspected. The nurse approached residents sensitively, especially where they needed encouragement to take the medication. A requirement was made at the last key inspection, and also at the two random inspections undertaken since then, that the home must ensure that residents are treated with respect at all times and that their wishes are respected. A protection of Vulnerable Adults (PoVA) referral had been made in October 2006, by hospital staff, which included an allegation that a carer’s verbal interaction with a resident was observed and considered to be unacceptable. Concern expressed from professionals present at the PoVA meeting that the home’s management at that time had not accepted the seriousness of this aspect of the allegation, and that the very challenging behaviour of the resident had been seen as some justification for the carers manner by the senior staff at the home at that time. (This was prior to the present acting manager being in post.) Disciplinary action was taken, and acting manager confirmed advised at this inspection that the carer has subsequently left the home. Whilst relatives comments on this aspect of care, received prior to the December random inspection where overwhelmingly positive, two had responded negatively. One relative commented, in respect to the enquiry what do you think could be improved; “Staff trained to provide more respect to residents. I saw one member of staff aggravate a resident once and nearly reduce (them) to tears.” Another relative reported having been told of an occasion when a carer’s response to a resident had been dismissive. The comment subsequently received from the Community Health Team on this aspect of care was; “ All members of our team have observed occasions when staff have walked into resident’s rooms without knocking. Staff have also been observed talking inappropriately to each other when involved in nursing care interactions. Raised voices towards residents have also been heard within the building on rare occasions, and some care interactions have been observed to be dealt with in an impatient manner.” On this occasion the inspectors did not witness any inappropriate interactions taking place between residents and staff. Staff were seen interacting positively with residents in the lounge areas after morning coffee on Gainsborough unit, and also at lunchtime. Two requirements regarding deficiencies in the physical environment that compromised privacy and dignity were made at the random inspection of October 19th 2006, one regarding the storage of incontinence aids, and another regarding the lack of an adequate curtain or blind on an observation window in Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 18 the door to a residents room. These were both found to be met at this and the last inspection. A complaint received by the CSCI shortly before the inspection was discussed with the acting manager. The complaint was that a deceased resident had been moved into the room of another resident who was in hospital, to allow for accommodation of an emergency admission, and that the deceased resident had been moved in a wheelchair by staff. The acting manager confirmed that this had happened. They advised that they had accepted an emergency admission, due to dire family circumstances, who required a ground floor room close to the nursing station. This person had arrived by ambulance two hours earlier than expected and before the undertaker had arrived to take away the deceased resident. She advised she had consulted with other staff and with the deceased resident’s family first, and that the move was done discretely so that other residents were not aware. When undertakers attend the home, they have to use a wheelchair for transportation of any resident who has passed away if they are on the first floor, as the lift cannot take a trolley. The acting manager acknowledged that the room of a resident in hospital should not have been used for this purpose, but that they had no option, having accepted the new admission. They also advised that the complainant had reported the matter to Craegmoor senior management, and was to be investigated fully internally. The home had no policy on maintaining a room empty for a certain period of time after a death. This is a decision for the home, but time should be allowed for the family to visit the room to grieve, to collect personal effects, and for the home to thoroughly clean the room. Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 19 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): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to be offered a choice of nutritious balanced meals. Residents with dementia may spend periods of time unsupervised. Staff are therefore not always able to stimulate and engage them, nor to respond to their presenting needs or the impact they may be having on each other. EVIDENCE: Three of the four standards were found to be met at the previous key inspection, and the forth was found to be met at next random inspection. One relative responding to the pre inspection survey prior to the December random inspection commented; “There is a warm welcoming atmosphere and there is a sense of concern for (………)’s individual needs. Residents are assisted to take part in activities and not left out because they can’t manage.” The care plan for one resident with dementia was seen to include a plan for socialising, which specified that they were to be encouraged to participate. During the morning, a number of residents on Gainsborough unit were observed in the adjoining lounges. A number of the residents spent a considerable amount of this time sleeping or dozing. During the first half of the Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 20 morning, eighteen residents with dementia were seen in the two adjoining lounges on Gainsborough, and for seven minutes there were no staff present. There was no disruptive behaviour. Two members of staff came through the lounge, and spoke with residents on the way through, and returned and joined them. The tea round was a lively occasion, with individual assistance being given to those who needed it. After the morning drink a number of residents became involved in a game of passing / kicking around a large lightweight exercise ball with the activities worker. Two residents on this unit, including a recent admission wandered freely around. The mood was positive. At 11.30 am there were nine residents in the lounges and six were sleeping. A carer commented “…….’s is asleep.” A resident responded, “They are always asleep.” One resident had their spouse present. Another resident was singing to them self. When asked by a member of staff asked if they were singing their favourite song, they responded, “ I can’t grumble, I’m just sitting here enjoying myself.” Another resident was asked if they liked living in the home, and they responded positively, “I do.” Two carers spent time interacting 1 to 1 with residents during this period, one was being assisted to knit. The staffing section of this report includes staff’s comments on the impact of staffing shortages. Another resident’s relative was spoken to in some depth. They advised that they were made to felt welcome in the home, and enjoyed being able to visit every day. At the last inspection a requirement was made that staff’s proficiency in English be assessed and monitored by the end of February 2007. This requirement arose out of comments provided by two general practitioners, who noted that they were aware that communication with nursing staff with strong foreign accents could impede communication, and several relatives who also expressed concern about this in their responses to the survey. Comments included; “There is a problem in understanding what is said by mother to some of the overseas staff and (vice versa)”, and “Although they have dementia they are still people and need communicating with.” A requirement was made that their proficiency be assessed; it was within timescale at the time of this inspection. The inspectors did not experience this to be a significant problem on the occasion of this inspection. The care plan for one resident with dementia, stated, “ staff to speak slowly and loudly to (………..) whilst giving him opportunity to raise (their) concerns, and staff to repeat instructions.” The lunch menu was battered cod or seafood pie, and chips, followed by chocolate pudding. One staff member advised that the current manager had introduced proper choices of food. A member of staff responding to the survey, considered food to be something the home does well, and confirmed that residents had choices. The mealtime on Gainsborough was seen to be calm Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 21 and unhurried. Those people who needed support with feeding were given that support. One resident became agitated, this was dealt with sensitively and knowledgably, in terms of knowing the capabilities of the resident. Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 22 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): 16,18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents cannot be assured that complaints will be responded to fully and to their satisfaction. EVIDENCE: The copy of the complaints policy contained within the new Service User Guide did not contain a timescale for responding to the complainant. The provider had been asked to reinvestigate a complaint by the CSCI, following the complainant having been dissatisfied with the homes initial response. At the previous inspection it was identified that an initial acknowledgement had not been received by the complainant, as per the policy. Contact had, however, been made within two weeks. A senior manager had arranged to fully investigate this complaint and was due to attend the home on 24th January 2007. This visit had been cancelled, and rearranged for 19th February 2007. A requirement was also made at that last, random, inspection, that a full list of complaints be maintained in the home. An empty folder was provided by way of a response to this, and the acting manager advised that there had been no complaints since they were in post. Full details of complaints received during the year and their outcomes were not available. Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 23 A complaint had been received by the CSCI shortly before the inspection. This was discussed with the Acting Manager who advised that the matter had also been raised within the company. This is detailed under standard 11. PoVA training had been provided, and PoVA referrals made by the home. In a recent case, the social worker had agreed the home should look into this. A senior social worker had followed this up by a review of the resident’s situation, and was unhappy to be informed that records had been lost. No regulation 37 report was received about this matter at the time. Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 24 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): 19,21,22,25,26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents cannot be assured that the environment is safe. Despite some recent improvements, they may find that the standard of decor and furnishings is not good. EVIDENCE: Six requirements relating to standard 26 were made at the random inspection in October 2006. These were all found to be met at the random inspection in December 2006, and on this occasion no unpleasant odours were detectable in the home. Staff on Constable unit confirmed that there were sufficient gloves and aprons available. These were seen at various points around the wing. The home has had a new washing machine since the last key inspection. Redecoration of some areas had occurred, and some furniture had been replaced, however, vanity units with damaged surfaces had not yet been replaced. The provider had confirmed in writing that fifteen beds identified as Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 25 damaged or stained had been replaced and two of these new beds, which were height adjustable, were seen to be in use at the last inspection. On this occasion, it was found that in one resident’s bedroom, there was an unlocked cupboard that contained a hot water tank. There was a sign on the door stating “ keep locked at all times.” The resident was in bed, and could not get up without assistance, however the room was accessible to other service users. Another resident’s room was seen to have been highly personalised. Their relative advised that they had done this, using mobiles and coloured lights, as well as personal mementoes. There was an inventory on the residents file. Day light bulbs had been placed in the resident’s rooms where tall trees had restricted the natural light, and the home reported that the council had trimmed the trees. The environment had not been adapted well to meet the needs of those with dementia; for example, there were no distinguishing signs on the individual room doors of residents on Gainsborough. The picture menus recently introduced were not being used. There was, appropriately, a very large plain clock in one of the lounges, and an old-fashioned grandmother clock in the other. In the day room on Constable, one set of curtains had been removed. The nurse in charge advised that all the curtains were to be replaced. The deputy manager said that the company had agreed to replace the carpet tiles in this room with a proper carpet suitable for the health and safety of the residents. The whole wing was planned to be re-decorated and re-carpeted in the corridors. Holes in the corridor wall on Constable where a keypad lock had been removed, found at the last inspection, had been made good. Bathrooms were uncluttered and contained paper towels and liquid soap. The home still did not have sufficient storage space. The acting manager confirmed that one double room was being used as a storeroom, and the room of a resident who was in hospital had two lifting hoists stored in it at the time of the inspection. The inappropriate use of bedrooms as storage was discussed with the acting manager who advised that the home was considering a slight reduction in numbers. Where protective corner coverings had been put in corridors to disguise and protect badly scratched and scuffed corners, these too were badly scratched and scuffed. Following the immediate requirement at the last inspection, the temperature of the bath hot water in B4 was re-tested. It measured 42°Celsius. There was a notice above the bath, dated 18/12/06, instructing staff to measure the water temperature before immersing a resident, and to record this temperature in the folder below the notice. No entry had been made since November 2006. In this room, and in other rooms, there were notices warning of “Very hot water”, Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 26 near washing and bathing facilities. These are superfluous and confusing if water temperatures are monitored and recorded regularly. All bathrooms had thermometers but no others had a temperature logbook. One outlet tested was found to be 40 degrees Celsius. The hot water in the bath in B7 was measured at 60°C. The nurse in charge immediately went and brought the maintenance man who adjusted the mixer valve. The maintenance worker advised that they had checked the temperature at this outlet within the last week, and their records showed this, however this finding demonstrated the urgency of instituting a more regular test monitoring system, a pre-immersion temperature record, and a review of mixer valve maintenance to reduce excessive fluctuations in temperature. Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 27 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): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents cannot be assured that there will always be sufficient adequately trained staff to meet all of their needs. EVIDENCE: The eight staff pre inspection questionnaires returned to the CSCI were generally positive; there were two areas of concern identified by some staff, décor, and staffing levels. In response to the question “do you feel residents needs are met?” one responded by indicating “usually”, and stated “staffing levels were a major issue.” Two members of staff commented that they were not able to spend time chatting with relatives or residents. Five commented that they were not able to answer call bells promptly, two commenting that they had to ensure that any resident they were attending to had to be left safely first. One stated that they could answer call bells most of the time when there were enough staff on shift. One commented “ sometimes we work under staffed which makes it very difficult to keep up with all residents needs, but we try our hardest.” The community team also expressed the view that there were staffing problems with staffing levels, in particular on Gainsborough unit. Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 28 Relatives’ views on staffing were elicited prior to the December 2006 random inspection. Comment received included; “The few staff who have been employed for a considerable time, are, in the main, very caring.” “Generally staff are satisfactory – one or two bad eggs and one or two excellent carers are employed.” “Often not many staff visible” “Insufficient staff numbers” “Reduce staff turn-over.” “More staff – to spend time with each person” “(The staff) try to maintain a standard of care even when there isn’t enough staff on duty “ ....”the constant turn over of staff is upsetting and doesn’t give you a feeling of confidence in the care.” When you walk onto the lounge you can instantly tell if it is a “good shift” as far as staff are concerned. “Training the carers, (could be done) more interaction with residents. The more able just wander round like lost souls, bored to tears.” The staffing compliment for Constable is 5 plus one nurse team leader, on the morning shift. There was a Registered Nurse Team Leader, a Registered Nurse bank nurse and 2 carers on duty. The team leader advised that the two agency carers booked had failed to arrive. The deputy manager was assisting with the medications to help out. Two members of nursing staff on Gainsborough spoken with were working double shifts on the day of the inspection, from 8 am until 2 and from 2 until 8. One of them was working the second shift to cover for a carer position. The staff were asked if they objected to such long shifts, they explained that they felt advantages weighed against disadvantages, and did not mind. During the morning they were supported by two senior carers, and two carers, one of which was an agency carer. The nurses advised that they were also short of one carer. The home also has an activities worker who was on duty. At a random unannounced inspection undertaken on 18th December 2006, it was found that 50 of carers on duty in the previous week were agency carers. A requirement was made that the home must reduce its reliance on agency staff by the end of March 2007. On the morning shift of this inspection there was only one agency worker, but the home was three care staff down across both units. The Clinical Governance Support Manager advised, then, that their professional opinion was that the high level of use of agency staff was part of the reason why the home had so many requirements. The nurses spoken with on this occasion advised that the majority of agency staff used were regular, and were all carers, not nurses. The Clinical Governance Support Manager advised that steps were being taken to achieve a competitive pay scale so that the home could recruit and maintain staff. Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 29 The recruitment file for a member of staff who commenced work in November was inspected. All required documentation was on file, CRB and references had been received prior to commencing employment. A nurse advised that six new members of staff had been recruited from overseas, but had yet to take up employment. The acting manager advised that training in dementia from Alzheimer’s society had been provided in 2005, and that some staff had left since and it had not been repeated. At the random inspection undertaken in October 2006, a requirement was made that the staff working in the home are provided with training in the use of physical interventions and de-escalation techniques. The timescale given for de-escalation training to occur was 31st January 2007. The provider’s written response to that inspection indicated that all staff are undergoing Craegmoor’s primary prevention training. A member of staff spoken to at the last inspection confirmed some of this training had taken place. Evidence that the training had taken place and the training analysis were requested. The training analysis, only, was provided. The acting manager acknowledged this was not up to date. The analysis showed the same level of NVQs as found at the key inspection undertaken in June 2006, when it showed seven senior carers and 24 carers and 13 out of the 31 carers having NVQ level 2, with 2 working towards it. In addition to this the home employs qualified nurses. The analysis did not include dementia training or deescalation training. Seven of the eight staff members replying to the pre inspection survey stated that they thought they had enough training for the job, and all eight stated were not asked to undertake tasks outside of their area of expertise. Seven of the eight staff members replying to the pre inspection survey stated that they had received induction training. A nurse spoken with advised that they had had yearly training updates for moving and handling, Protection of Vulnerable adults, Health and safety, fire, food hygiene and handling. The home had a policy to renew staff CRBs every 3 years. The expiry dates were on a list in the manager’s office. Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 30 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): 31,32,33,35,36, 37,38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents cannot be assured that their health and safety will be adequately protected, that the staff working with them will be adequately supervised, or that requirements made of the home by the CSCI will be met in a timely way. EVIDENCE: There has been a lack of continuity in the management of the home and also within the management structure outside of the home. Since the last key inspection an acting manager, for whom a registration application was expected but was not received, has resigned. The deputy manager managed the home for a period, and another acting manager has been appointed. Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 31 The home has been without a Registered Manager since August 2004. During this time there have been three acting managers. The Registration Certificates reflect that there have been four named people who have held the Responsible Individual position in this period. Several of the staff responding to the pre inspection survey stated that they considered the current manager was approachable, constructive, and would follow up any complaint, no matter how small. Seven staff replying indicated that they felt able to discuss concerns with the manager, one stated that they were told initially to discuss any concerns with a senior or the nurse. One member of staff commented on the impact on staff morale of working in a home where so many “negatives” were flagged up, via the CSCI reports. One member of staff commented that they thought the acting manager was trying their best to achieve the improvements wanted, “ sometimes too hard.” No regulation 26 visits reports have been received by the CSCI since late November 2006, however the deputy manager confirmed that these visits were being regularly carried out. As noted under section 1, no survey of resident views have been published within the last year. Staff supervision had not yet been put on line throughout the home. Some staff had had formal supervision; two members of staff spoken with confirmed that they had received supervision, and several of the staff responding to the pre inspection survey referred to supervision taking place. A number of staff files were sampled and these contained supervision records. A supervision schedule had been drawn up that would achieve all staff having received an initial supervision session by the end of January 2007. A requirement on this was made at the last key inspection and a timescale given to have this on line by end of August 2006. It was repeated at the random inspection undertaken in October 2006, when the timescale was extended to December 31st 2006. The acting manager advised that the home no longer holds petty cash for residents. They advised that any held was banked in December 2006 and relatives were advised in writing. Where purchases had been made on behalf of residents, receipts were seen to have been signed by two members of staff. A requirement was made at the last two random inspections that evidence of interest paid by the company into residents’ accounts must be provided. The provider’s response to this was that evidence was available on Craegmoor’s live information systems, but this could not be accessed at the last random inspection. On this occasion it was accessed, and there was no evidence of any interest paid in 2006/7 on several statements inspected that had an opening balance. One resident had an opening balance of over a thousand pounds in March 2006, and minimal interest added to their account at the same time. This resident’s current balance was well over £2000, and there was no record of any interest being paid in the last ten months. One of the residents tracked also had a significant opening balance in March 2006; their account showed Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 32 this to be slightly reduced in January 2007, but no interest payments were detailed within this eleven-month period. The policy on interest payments was requested, a draft policy that stated interest would be paid quarterly was provided. The upstairs sluice on Constable was locked and it was clean and tidy, however cleaning agents were placed on an open shelf. There was no Coshh (Control of Substances Hazardous to Health) cupboard in this sluice. The deputy instructed the domestic to remove the items to her trolley and take them to the cupboard downstairs. A copy of a letter from the fire officer to the home was received by the CSCI in the week prior to the inspection. This stated that the home had inadequate provision of means of escape, leading to a place of safety, from the premises, and that this was identified in a fire safety audit undertaken on 11th January 2007. The letter listed a series of measures that could be taken to comply with the regulation. The fire officer has subsequently advised the CSCI that the home has been in contact with him to discuss the requirement. On the day of the inspection, a further hazard was identified. A quantity of files and feeds were stored at the top of the stairs. This was a fire hazard and the deputy manager agreed to arrange their removal at once. On Gainsborough, the fire exit through door 12 to the external door was blocked by the storage of two armchairs. The stairwell here was stacked with boxes of incontinence pads. The deputy manager removed the chairs as soon as she was made aware of the hazard. Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 33 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 1 2 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 3 2 X 3 2 X X 1 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X 2 2 2 1 Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 Requirement The Statement of Purpose must contain all of the information required by regulation, must describe the needs it can cater for accurately, and must state that the Registered Manager’s post is vacant. The Service User Guide must be amended to include all items listed under regulation 5. A copy must be distributed to each resident. The home must operate within its categories of registration. The home must apply immediately for a variation in respect of the residents who are outside these categories by virtue of age, clinical diagnosis or registered numbers. Full records must be kept of turns/tilts occurring, and these should include the position/side of the resident after the turn/tilt, and must reflect the care plan. The individual rooms of residents who are in hospital must not be used for other purposes. Timescale for action 28/02/07 2. OP1 OP2 5 28/02/07 3. OP4 Care standards Act 2000 Section 15 28/02/07 4. OP8 17(1) Sched (3) (k)(n) 12(4)(a) 21/02/07 5. OP10 28/02/07 Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 35 6. OP10 7. 8. OP11 OP16 9. OP16 OP37 10. OP22 11. OP24 12. OP25 OP38 13. OP27 14. OP12 OP27 15. OP30 16. OP30 The home must ensure that service users are treated with respect at all times and that their wishes are respected. 12(4)(a) The home must have a policy on death and dying which addresses the procedures following death. 22(5) The correct complaints policy must be available to all residents. This is a repeat requirement from the previous inspection. 17(2) Sch A full record of complaints, 4 11 including details of investigation and any action taken must be maintained in the home. This repeat requirement is within timescale. 23(2)(l) Adequate storage space must be provided. This is a repeat requirement from the previous 3 inspections. 16(2)(c) Repairs must be made to furniture and fittings in bedrooms on Gainsborough. This repeat requirement from the previous 3 inspections was within the extended timescale. 13(4)(a)(c The door to a hot water tank ) within a resident’s room must be kept locked in accordance with the written instruction. 18(1)(a) The home must reduce its reliance on agency staff. This repeat requirement is within timescale. 18(1)(a) Staffing levels must be maintained so that call bells can be answered promptly and residents with dementia are not left for periods unattended. 18(c)(i) The Registered Persons must 13(7) provide evidence of staff training on the use of physical interventions and de-escalation techniques. 18(c)(i) The Registered Persons must DS0000024351.V328726.R01.S.doc 12(3)(4) & (5)(b) 19/02/07 15/03/07 28/02/07 31/01/07 31/03/07 28/02/07 26/02/07 31/03/07 28/02/07 28/02/07 31/03/07 Page 36 Catchpole Court Residential And Nursing Home Version 5.2 13(7) 17. OP30 18(1)(a) 18. 19. OP31 OP35 CS Act 2000 Sec 11 13(6) 20 provide adequate training in dementia for all staff working on Gainsborough unit, and provide evidence of this. Staffs’ proficiency in English must be assessed and monitored. This repeat requirement is within timescale. A registered Manager application must be submitted. The home must pay interest into accounts held by the company on behalf of residents in accordance with its draft policy. Staff must receive regular formal supervision that is documented. This is a repeat requirement from the previous two inspections. The Registered persons must ensure that stairwells are keep clear and not used as storage areas such that they presents a heath and safety hazard to residents. Hot water outlets must be maintained at or around 43 degrees Celsius. The home must comply with the requirements of the fire officer as stated in his letter of 18th January 2007. 28/02/07 31/03/07 30/04/07 20. OP36 18(2) 31/01/07 21. OP19 OP38 13(4) 21/02/07 22. 23. OP25 OP38 OP38 OP19 13(4) 23(4) 26/01/07 18/04/07 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 OP1 Good Practice Recommendations The Service User Guide should contain a description of the individual accommodation and communal space provided, DS0000024351.V328726.R01.S.doc Version 5.2 Page 37 Catchpole Court Residential And Nursing Home 2. OP19 3. 4. 5. OP24 OP33 OP33 6. OP33 and residents’ views of the home. The environment for residents with dementia should be developed to better meet their needs, with identifying features on individual rooms, and additional sensory stimulation. All residents’ rooms on the dementia unit should have photographs or identifying symbols on them. The views of residents and relatives should be sort regarding staff working long shifts. The results of the resident survey should be published and made available to current and prospective residents, their representatives and other interested parties, including the CSCI. Regular resident meetings should be held. Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 Catchpole Court Residential And Nursing Home DS0000024351.V328726.R01.S.doc Version 5.2 Page 39 - 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. 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