CARE HOMES FOR OLDER PEOPLE
Cathedral View Nursing Home Kenwyn Church Road Truro Cornwall TR1 3DR Lead Inspector
Lynda Kirtland Unannounced 25 August 2005 0930 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cathedral View Nursing Home D52-D04 S46307 Cathedral View Nursing Home V221021 250805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Cathedral View Nursing Home Address Kenwyn Church Road Truro Cornwall TR1 3DR Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01872 222132 01872 240974 Cathedral View Limited Mrs Lynde Gilbert Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26), Physical disability (26), Terminally ill (26) of places Cathedral View Nursing Home D52-D04 S46307 Cathedral View Nursing Home V221021 250805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Service users to include up to Service users to include up to (PD) Service users to include up to Total number of service users 26 adults of old age (OP) 26 adults aged over 65 with a physical disability 26 adults with a terminal illness (TI) not to exceed a maximum of 26 Date of last inspection 18 January 2005 Brief Description of the Service: Cathedral View Limited owns two registered care homes. These are Cathedral View Residential Home and the other is Cathedral View Nursing Home. Both homes are located on the same site. Cathedral View Nursing Home is registered to accomodate 26 elderly service users in need of personal and nursing care. The home provides single bedrooms for the majority of service users although four rooms are registered for shared accommodation. Bedrooms are situated on two floors and there is a lift. There are two lounges and a large dining room for service user use. All facilities for service users are accessible for those who may have limited mobility or in need of specialist equpment such as wheelchairs. There are extensive accessible gardens for service users use. There is sufficent parking outside the home. The home is situated near to the centre of Truro city which has good transport links into the main town and surrounding areas. Mrs Lynde Gilbert is the registerd Manager for both homes and has the Registered Mental Nurse qualification. Mrs Victoria Parsons is the matron and manages the home on a day to day basis. Cathedral View Nursing Home D52-D04 S46307 Cathedral View Nursing Home V221021 250805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector visited Cathedral View nursing Home on the 25 August 2005 and spent five hours at the home. This was an unannounced visit. The purpose of the inspection was to gain an update on the progress of compliance to the requirements that were identified in the last inspection report dated 18 January 2005. In addition the inspector focused on the following key areas of care: health care, leisure, environmental, complaints, and some staffing and management areas. On the day of inspection 25 service users were resident in the home. The methods used to undertake the inspection are to meet with a number of residents, staff, the registered manager and registered provider to gain their views on the services that Cathedral View Nursing Home offer. Cathedral View Nursing home records, policies and procedures were examined and the inspector toured the building. This report summarises the findings of this inspection. What the service does well:
Residents commented that Cathedral View provides good quality care and accommodation. All residents said that they felt that they were consulted about their care needs which staff met. Residents commented that they have access to health care and felt that all their health needs were met to a ‘high’ standard. Documentation evidenced that access to local and specialist medical care occurs. Specialist equipment to assist in the moving and handling of residents and aids such as mattresses, grab rails, and mobility aids were in sufficient supply at the home. Residents confirmed that there was a varied and stimulating programme of activities that is provided by the home and local community. An activity coordinator visits the home four days a week and offers a programme of activities. This is displayed to promote this service and encourage others to participate. Residents are also encouraged to develop their own individual interests and evidence of this was seen throughout the inspection. Residents felt their visitors were welcomed to the home. Residents commented that they have the choice where to eat their meals, either in the attractively furnished dining area or in their own rooms. An observation of the lunchtime meal was positive with residents socialising and staff interacting with residents in a positive manner.
Cathedral View Nursing Home D52-D04 S46307 Cathedral View Nursing Home V221021 250805 Stage 4.doc Version 1.40 Page 6 Residents and staff stated that if there were any issues they felt able to approach the registered manager directly and that their ideas would be listened to and where appropriate acted on. The home actively seeks residents views by holding a three monthly residents meeting. Residents and staff commented that there are sufficient staffing levels on duty. Residents made various comments about staff such as; they are ‘kind’ and ‘caring’ and felt that the staff team were respectful. Staff confirmed attendance on training courses, which they felt, was beneficial and assisted them in their daily work. The registered manager has taken active steps to develop this area further. Cathedral View is a clean and attractively furnished home. Staff are aware of what measures are needed to promote infection control. Residents were positive about the level of cleanliness and the laundry provision in the home. Cathedral View has access to well-maintained gardens that are accessible for residents use. Cathedral View ensures regular maintenance of the home to ensure the health and safety of all who live, work or visit the home. What has improved since the last inspection? What they could do better:
From this inspection two requirements were identified. The review of the bathing facilities has been re notified. In addition a requirement to review
Cathedral View Nursing Home D52-D04 S46307 Cathedral View Nursing Home V221021 250805 Stage 4.doc Version 1.40 Page 7 lighting in the home and ensure that a lighting cover is installed in the laundry area has been identified. Residents commented that whilst they are satisfied with the quality and provision of food at the home, they would like a further review of the menus. The registered manager stated that this would be addressed with the involvement of residents and the catering staff. Residents and staff could not think of any further improvements that Cathedral View could make. This inspection highlighted that Cathedral View Nursing Home provides a good standard of care to residents. The inspector would like to thank the residents, staff and management team for their assistance during this inspection process. 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. Cathedral View Nursing Home D52-D04 S46307 Cathedral View Nursing Home V221021 250805 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Cathedral View Nursing Home D52-D04 S46307 Cathedral View Nursing Home V221021 250805 Stage 4.doc Version 1.40 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: These standards were assessed at the previous inspection in January 2005 and were viewed as meeting the requirements of the national minimum standards. Therefore they were not inspected on this occasion. Cathedral View Nursing Home D52-D04 S46307 Cathedral View Nursing Home V221021 250805 Stage 4.doc Version 1.40 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 8,10 Health care needs are met to a good standard for all residents. The staff at the home builds positive relationships with residents that are based upon the residents dignity and privacy. EVIDENCE: Residents commented that health needs are met by the staff at the home and by external professionals to a high standard. Detailed records of all health professional visits to individual residents further evidenced this. The home has positive relationships with local and specialist health services. Cathedral View also has access to a variety of aids and equipment to assist residents in meeting their health needs in an appropriate manner. All residents spoken with stated that staffs display a high standard of respect in their daily interactions. Residents stated that staffs ensure that their privacy and dignity is maintained and could not see how this area of care could be improved. The inspector noted that the atmosphere of the home and residents appeared to be relaxed. Residents commented staff ’ were ‘kind’, ‘sensitive’ and ‘nothing is too much bother’. Residents confirmed that they have a choice as to when to rise/ retire to bed, receive their mail unopened, have access to a private phone and can receive visitors in private. In addition the inspector observed staff interacting with residents in a professional manner at all times, alongside a sense of humour when appropriate.
Cathedral View Nursing Home D52-D04 S46307 Cathedral View Nursing Home V221021 250805 Stage 4.doc Version 1.40 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 standard(s) 12,13,14,15 Cathedral View provides a programme of activities to promote and encourage the pursuit of residents social, educational and leisure needs. Flexible visiting arrangements are in place and visitors are welcomed at the home. The registered manager in consultation with residents will review the provisions of meals in the home; to ensure a high standard of dietary provisions are maintained. EVIDENCE: From discussions with residents the majority commented that there is ‘enough to do’ during the day. The inspector noted on the day of inspection a variety of activities taking place; socialising in the dining area over lunch, music and receiving visitors. In addition some residents were getting ready for a ‘mystery’ bus tour in the afternoon which all said they look forward too and enjoy. Cathedral View employs an activity coordinator who provides a variety of activities on a daily basis that are advertised. Residents commented that they are encouraged to join in these activities and to partake in their own individual pursuits i.e. paintings, making of cards, reading. Some residents commented that they prefer to spend time in their own company and this is respected. Residents were able to recall a list of activities that occur such as exercises,
Cathedral View Nursing Home D52-D04 S46307 Cathedral View Nursing Home V221021 250805 Stage 4.doc Version 1.40 Page 12 monthly communion, games, mobile library, talking books to name a few. Individual interests are recorded in residents’ individual files. There is a flexible visiting policy and residents determine where they meet with their guests. Residents felt their visitors were welcomed to the home positively and could not think of improvements in this area. Residents confirmed that they were aware of advocacy groups and could access age concern, solicitors, family or ask the staff for advise. The inspector observed a lunchtime meal. It was evident that the majority of residents choose to have their meals in the attractive dining area. Of those who wish to have their meals in their rooms, these were delivered to each room on individual trays by care staff. Comments from residents who received their meals in their rooms were that meals were delivered hot and presented in a ‘nice way’. Of the residents who needed assistance with their meals, the inspector observed staff socialising with the resident during the meal so no meals were undertaken in silence. Residents said that there is a choice of main meal. The menus inspected demonstrated that there are a variety of meals. Residents in the main made positive comments to the inspector in the variety and quality of food provided. However they would like to have a further review of the menus. This was relayed to the registered manager who agreed that this would be addressed. The inspector did not meet with the chef on this occasion, but met with some kitchen staff. From discussion with these staff it was evident that they are aware of residents dietary needs and the importance of infection control in the kitchen area. This part of the standard will be inspected in further detail at the next inspection. Cathedral View Nursing Home D52-D04 S46307 Cathedral View Nursing Home V221021 250805 Stage 4.doc Version 1.40 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 standard(s) 16,17 Cathedral View has an appropriate complaints and whistle blowing policy. Residents, their representatives and staff are confident to raise any concerns. Residents are aware of advocacy groups to ensure that their legal rights are protected. EVIDENCE: Cathedral View has completed policies in respect of the complaints procedures. Cathedral View has received one expression of concern that was investigated fully and not substantiated. CSCI have not received any complaints about the home. From the inspectors discussions with residents all stated that they had no concerns about the care or facilities that were provided by the home. Staff likewise commented they had no current concerns. Residents and staff all commented that they felt able to approach the management team if they had any concerns. From inspection of the homes complaint form it was recommended that this be expanded to cover the whole complaints process so that all paperwork is kept together. Since the inspection the registered manager has taken on board this advice and amended this form which now demonstrates how the complaint was investigated and views from the complainant as to if they are satisfied with the outcome. Resident names are placed on the electoral role in order that they can participate in the political process, if they wish. Residents are aware of independent advocacy groups, solicitors or may use family members to represent them if they wish.
Cathedral View Nursing Home D52-D04 S46307 Cathedral View Nursing Home V221021 250805 Stage 4.doc Version 1.40 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 standard(s) 19,20,21,22,24,25,26 The home and grounds are well maintained providing a safe environment for residents, staff and visitors. Indoor and outdoor communal facilities are accessible. Cathedral View Nursing home provide a good standard of décor and furnishings creating a comfortable and safe environment for those living there and visiting. The registered provider has invested in the homes furnishing and décor to improve the facilities in the home. The home is clean making it a pleasant place for service users to live in. The bathroom facilities are under review to improve this facility for residents at the home. EVIDENCE: The home is well maintained, clean, bright and comfortable, and overall is suitable for residents needs. There is suitable space to meet the needs of residents. All bedrooms have good quality furnishings and fittings, and residents can bring their own furniture to the home. Bedrooms are decorated according to individual preferences and tastes. Residents confirmed that they were happy with the high standard of their
Cathedral View Nursing Home D52-D04 S46307 Cathedral View Nursing Home V221021 250805 Stage 4.doc Version 1.40 Page 15 accommodation. Residents who share rooms were pleased with this arrangement and felt there were ‘some benefits’ in sharing rooms due to company. Communal areas are decorated and furnished to a good standard. The dining facilities open out into an attractive garden area, which is accessible for all residents. Residents are able to access all parts of the home. The home was clean, hygienic and there were no offensive odours on the day of the inspection. The laundry has satisfactory facilities and is well organised. Laundry and domestic staff were aware of COSHH and the importance of infection control. The previous inspection identified some environmental requirements. The first was that the Registered Providers must review the current bathing facilities with a view to improving access for both residents and staff. This has been undertaken and the home is aiming to redesign and refurnish some of the bathroom areas. This requirement remains in progress. Two other requirements were identified which the home has addressed and met. Firstly the Registered Providers must review the current nurse call facilities with a view to their position in communal areas and the need to extend the number of call points. This has been addressed and it was observed that there are more call facilities in the communal areas. Secondly that the Registered Provider should make arrangements for an assessment of the premises and facilities by a suitably qualified person with specialist knowledge of the client groups catered for. CCSI have received a copy of this assessment, which could not identify any further alterations needed to the home. On this inspection it was observed that light coverings must be fitted in the laundry area. Lighting in some resident’s rooms needs to be increased to 60 wattage. The registered manager agreed that in shared rooms she would review the screening around the washbasin area if residents were able to use this facility so that privacy is promoted further. The registered manager stated that it has been arranged for all the carpets in the home to be shampooed Cathedral View Nursing Home D52-D04 S46307 Cathedral View Nursing Home V221021 250805 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Suitable trained and experienced staffs are employed in sufficient numbers at all times to meet residents care needs. EVIDENCE: On the day of inspection four care staff, and two qualified nurses one who was in charge of the shift, domestics, handyperson, kitchen staff, laundress and registered manager were on duty. The registered manager stated that the staffing ratio during waking hours is aimed to be 1:4-5. At night there are two waking night staff at RN level 1, a care assistant and the registered manager on call. The registered manager stated that there are no staff vacancies. The home also employs an activity coordinator. Residents were satisfied with the level of staffing in the home and all were complimentary about the care and approach they receive from the staff team. From discussion with staff they all commented that they felt that there is sufficient staff on duty and that they ‘work as a team’. The inspector observed staffs that were competent in their work. Cathedral View Nursing Home D52-D04 S46307 Cathedral View Nursing Home V221021 250805 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The home is maintained to ensure the health and safety for all who reside, work or visit the home. EVIDENCE: Cathedral View Nursing home undertakes regular health and safety checks in the home i.e. fire drills, Legionella, emergency lighting, training of staff in the areas of COSHH, moving and handling and first aid. In addition inspections from other authorities occur and no issues have arisen from these inspections. Cathedral View Nursing Home D52-D04 S46307 Cathedral View Nursing Home V221021 250805 Stage 4.doc Version 1.40 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 2 3 x 3 2 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x x x x x x x x 3 Cathedral View Nursing Home D52-D04 S46307 Cathedral View Nursing Home V221021 250805 Stage 4.doc Version 1.40 Page 19 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 21 Regulation 23 Requirement The registerd Provider must review the current bathing facilities with a view to improving access for both service users and staff, and provide the CSCI with an action plan, including timescales. This is re notified to you. (2nd time). Lighting in service users rooms must be sufficent. IN addition installation of a light cover in the laundry area must occur. Timescale for action 30.12.05 2. 25 23 30.12.05 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 15 Good Practice Recommendations A review of menus should occur with service users and staff involvement. Cathedral View Nursing Home D52-D04 S46307 Cathedral View Nursing Home V221021 250805 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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