Inspection on 06/06/09 for Cavendish Care Home

This inspection was carried out on 6th June 2009.

CQC found this care home to be providing an Poor service.

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

Other inspections for this house

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 07/08/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Cavendish Care Home 301 Stroud Road Gloucester GL1 5LF Lead Inspector Sharon Hayward-Wright Unannounced Inspection 6th June 2009 09:00 DS0000072774.V375809.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Cavendish Care Home DS0000072774.V375809.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Cavendish Care Home DS0000072774.V375809.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cavendish Care Home Address 301 Stroud Road Gloucester GL1 5LF 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) 01452 521896 01452 307399 Cavendish Care Home Ltd Mrs Pamela Ann Teemul Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (24) of places Cavendish Care Home DS0000072774.V375809.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) 2. Dementia aged 65 years or over on admission (Code DE(E)) The maximum number of service users who can be accommodated is 24. First inspection following a change in the registration of the home. Date of last inspection Brief Description of the Service: Cavendish Care Home is a large extended house situated on the outskirts of Gloucester City offering personal care to those who have dementia. The Home is on a main bus route and has off road parking to the front and rear. There is a small enclosed back garden and a patio area to the side of the property. Internally accommodation is laid out on two floors with a passenger lift accessing the first floor. There are two lounge areas with combined dining areas, and a small sitting area by the front door serves as a third. Each of the single and double bedrooms has a wash hand basin and is near to communal toilets and bathrooms. Four new bedrooms have added to the upstairs and they provide en-suite facilities. The current fees at Cavendish at the time of writing this report range from the Local Authority funded rate of £486.25, up to £667.01. People who fund their placements privately have additional service included in the fees and these include toiletries, newspapers and chiropody. People who have their care funded by Community and Adult Care Directorate are able to arrange on an individual basis different payment options for these additional services. Information about the home is available in the Service User Guide, which is Cavendish Care Home DS0000072774.V375809.R01.S.doc Version 5.2 Page 5 issued to all prospective residents. The home does not display its previous inspection report, although does display a notice confirming it is available, and inviting people to request a copy to read if they wish. Cavendish Care Home DS0000072774.V375809.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. This inspection was carried out by two inspectors over two days in June 2009. We requested an Annual Quality Assurance Assessment (AQAA) prior to this inspection. We received it on time. Despite being brief it contained information about where the service feels it provides good care and the improvements they have planned for the next 12 months. The Dataset information provides us with numerical information about the service. We looked at other information we have received from or about the service from other stakeholders. This should include where the home notifies us of any incidents that affects the well being of people who use the service. We looked at a number of systems the service has in place to include care records, activities, food provision, staff supervision and training, complaints, medication and maintenance records. We spoke to people where able to gauge their views on the service provided and any visitors to the home. We also spoke to staff and observed interaction between staff and people who use the service and the results of all these have been used in this report. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: People who use the service have access to a varied diet and are able to make choices regarding their meals. The standard of the food we observed was very good. Cavendish Care Home DS0000072774.V375809.R01.S.doc Version 5.2 Page 7 People are not admitted to the home without first having their needs assessed and assurances that these can be met. The mental health part of the care plans and assessments look at the person as a whole and recognise skills that person is able to use. Some activities are being provided early evening to help people to settle prior to them going to bed which is good practice. What has improved since the last inspection? What they could do better: The home is not identifying peoples physical health needs and acting upon the information gathered. For example people are being weighed but the staff are not recognise when people are losing weight and acting upon this. Some improvements are needed to the medication systems used by the home, for example to make sure that medications are stored at the manufacturers recommended temperature. We identified that at times the home is not respecting people’s privacy and dignity for example the use of seat covers on chairs in the communal area is institutionalised practice. Also the staff were not observed to ask people if they would like to wear a ‘bib’ at meal times they were just putting them on. We identified a number of environmental issues to include odours and the standard of cleanliness needs to be improved. The home needs to review their staffing levels to make sure people’s needs are being met. Some improvements are needed with staff training to make sure staff have the skills and knowledge to also meet peoples needs. The company’s audits had not identified the shortfalls therefore their quality assurance systems need reviewing. Cavendish Care Home DS0000072774.V375809.R01.S.doc Version 5.2 Page 8 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Cavendish Care Home DS0000072774.V375809.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 Cavendish Care Home DS0000072774.V375809.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to provide prospective people and their representatives with information about the home and to make sure an assessment of peoples needs is undertaken prior to admission. EVIDENCE: This is the homes first inspection following a change in the registration status. A copy of their Statement of Purpose was examined and it has been amended with the changes. Prospective people are able to ask for a brochure which contains a copy of the homes Statement of Purpose and Service Users Guide. Contracts for people who use the service have also been amended to reflect the recent change in registration and two were randomly seen at the Registered Providers head office but were not examined in detail. Cavendish Care Home DS0000072774.V375809.R01.S.doc Version 5.2 Page 11 The pre admission assessment of a person recently admitted to the home was examined. As this person was from outside Gloucestershire a telephone assessment had been completed by the Registered Manager with a member of staff from the care home they were staying at. Additional written information has also been obtained about this person’s care needs from other professionals involved in their care. The assessment contained detailed information about this person’s care needs. We did not examine at this inspection the letter the Registered person would send to confirm the home could meet their needs. Cavendish Care Home does not provide intermediate care. Cavendish Care Home DS0000072774.V375809.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people who use the service are not having their health and personal care needs met. Care records do not always provide staff with sufficient instruction on how to meet people’s needs. The principles of respect, dignity and privacy are not always put into practice. EVIDENCE: We examined the care of three people in detail and this included reading care records, speaking to the person, observing staff interacting with them and speaking to staff. We also looked at a number of other peoples specific care plans. The home is registered to care for people with dementia and each person had a ‘whole picture plan’ and ‘strength assessment’ which provides information about peoples mental health. Reviews were in place for these. Each person has Cavendish Care Home DS0000072774.V375809.R01.S.doc Version 5.2 Page 13 a risk assessment profile and dependency score and ongoing reviews were in place for these. We found that some people did not have care plans in place for specific needs for example, one person requires a care plan for epilepsy, another person requires a plan for the management of their nutrition and weight loss and another person was found to have recorded in their daily records that they have a red sacral area. The person with the red sacral area will need to be closely monitored as they have the beginnings of a pressure area. When looking at other care plans for peoples physical needs we found that they were not personalised and often did not contain detailed instructions for staff to follow. For example care plans for personal care did not always mention about how often people are offered baths and what care is needed for nails, teeth and hair. One relative of a person who uses the service said they would like the home to devise a way of informing the families when their relative has had a bath instead of the families having to keep asking the staff. The Registered Manager said she would look into this. One person whose care was examined in detail was wandering at night but the night care plan does not provide staff with guidance on how staff can manage this. This person has also lost weight and if they are up at night the staff should be providing them with snacks. The Registered Manager said they did do this, however this was not recorded in any of the care plans. Following the first day of the inspection the Registered Manager reviewed the night care plan format. The new format requires more information to be completed to include people’s choice on what time they go to bed and what time they get up, which is good practice. We identified four people who had lost weight in either a short period of time or over a year. There was no evidence in the care records that people’s weight loss has been recognised. There was also no evidence to suggest that advice had been taken from a Dietician or GP. We did find that people are offered ‘snacks’ in between daytime meals and these are recorded but the home must urgently review people’s weights and put an action plan in place to address any weight loss. We looked at the care of two people who are diabetics. Both people are having their blood glucose levels monitored, but it is not clear at what time of the day this is being done. The Registered Manager said it is normally done prior to the person having their breakfast but then admitted that some of blood sugar levels had been assessed after the person had eaten. We also found in some cases that staff were writing in the reviews that the blood glucose readings were ‘stable’ or ‘remained unchanged’ when this clearly was not the case as there were different readings. A review of how the home manages people with diabetes needs to be undertaken urgently. Care plans relating to this must provide staff with information about when readings are to be taken and what Cavendish Care Home DS0000072774.V375809.R01.S.doc Version 5.2 Page 14 action to take if any is needed. It also needs to be clearer at what point staff may need to contact an external health professional in relation to this. One persons care plan said they should be toileted regularly. We observed this person sitting in the front lounge for about 8 hours without being moved. We asked the staff how they were meeting this persons toilet needs and they told us that the person was wearing a high absorbency continence pad and would be taken to the toilet at 3.30pm. This person is also immobile and cannot change their position without staff help; this is not acceptable practice as people must have their position changed frequently for comfort as well as for the prevention of pressure sores. We also observed another person in bed who had not had their position changed. Staff said that they could not do this successfully as the person tended to roll back onto their back. The home need to seek advice from the appropriate health care professional on how this person’s position can be changed whilst in bed. We found an armchair placed halfway down the side of this person’s bed. It has sometimes been the practice of care staff to place armchairs along side people’s beds to prevent them from falling out of bed. However this is poor practice and could present as more of a risk to the person if they fell against it and could be viewed as a form of restraint. This practice needs to stop and an assessment of this person’s risk of falling out of bed must be reviewed and alternative measures put in place. Some people are having their food and fluid intake recorded. However we did find some inconsistencies with these records being completed. Some people had gaps where nothing had been written for mealtimes or there were long timescales between people having any fluids recorded. If people are assessed as requiring their fluid and food intake to be recorded then this must take place. A member of staff must also review these charts to identify if people are having low intake and put actions in place to address this. When we arrived at the home on the first day of the inspection at 8am a number of people were wandering around the ground floor. The care staff were assisting people to get up so there was limited supervision of these people. As breakfast was served late a number of people were becoming agitated and were saying “when are we going to get something to eat” and “nothing to eat”. Breakfast finally started to be served from 10.10am (this is discussed further in Daily life and Social Activities outcome group). We asked the Registered Manager when people would have last had something to eat and she said the night before at about 8.30 pm. This is too long for people to wait for food especially people with diabetes. One person whose care we examined in detail had no records in place to provide evidence for when they last had a drink, as we did not see this person offered a drink until 10.40am when they had their breakfast. This is not expectable practice. This person was also observed to have a yellow coated tongue and a sticky eye. This was reported to the Registered Manager. Cavendish Care Home DS0000072774.V375809.R01.S.doc Version 5.2 Page 15 We observed that a number of people who were assisted by the staff to wash and dress had not had their hair brushed. It was written in one person’s care records that the night staff had brushed their hair but this clearly was not the case. Otherwise people were tidily dressed. During the tour of the home we were unable to find in some people’s room any equipment for them to have mouth care or we found that their toothbrushes were dry. A system must be put in place to make sure people are offered assistance with mouth care and they are provided with equipment as this is included if people are privately funded. Otherwise staff should be monitoring when peoples toiletries are low and informing their representative. People do have access to external health professionals to include GP’s, Community Nurses, Chiropodist and Opticians. Records are maintained of these visits. We spoke to a number of relatives and they said they were happy with the care provided to their relative. We issued the home with an immediate requirement for the Registered Persons to make sure the home is conducted in such a way to promote and make proper provision for the health and welfare of people who use the service. This relates specifically to people not getting breakfast until 10.15am onwards, peoples positions not being changed and people not being taken to the toilet. The systems the home has in place for the management of medications were examined. We observed the administration process and safe systems were used however when taking the medication to the person best practice is to take the medication administration record (MAR) as well. The medication administration records were checked and no gaps in the recording were found. Records were in place for medication received into the home, administered to people and where required returned to the pharmacy. Dates of opening were observed on boxed medication and eye drops. The home needs to review the storage of prescribed creams as these were seen being stored on the hand rail on the upstairs landing, which is unsafe practice due to the medical condition of people in the home. Hand written entries should be checked and signed by a second member of staff for safety. The home must also make sure that medications are stored at the recommended manufactures temperature in both the trolley and office. At the time of the inspection the home did not have any controlled medication. The Registered Manager said that staff receive external medication training. A list of medications and side effects are available for staff. The home needs to look at incorporating the Mental Capacity Act 2005 guidance into medication systems by asking people for example where they would like their medications administered etc. We observed staff speaking to people in a respectful manner. Cavendish Care Home DS0000072774.V375809.R01.S.doc Version 5.2 Page 16 We did find in the communal areas that seat covers are used to protect the chairs in case people are incontinent; this is institutionalised practice and should cease. The Registered Manager said that some people like to have one and this is fine, if it is the person’s choice but it needs to be clearly documented in their care plan. We also found a pile of ‘bibs’ stored on the table in the front lounge and staff automatically put them on people without asking them if they would like to wear one. Again this is institutional practice; however the Registered Manager said people like to wear them but people should always be asked first. Cavendish Care Home DS0000072774.V375809.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to an activities programme that is based on their needs and abilities. Staff are not always encouraging people to make their own choices about heir daily lives. EVIDENCE: The home has an activities coordinator that works for two shifts per week but this is going to be increased to 3 shifts per week. The Registered provider said he has plan in the future to increase the activity hours. External entertainers visit the home and a poster was seen displaying the next one which was the week during the inspection. An activity file was seen that listed all activities for May 2009 and these included external entertainer and in house activities. The Registered Manager has arranged for some early evening activities and these usually take place about twice a month and she said people enjoy these. The care staff provide activities at other time and music was playing in one of the communal lounges and the TV was on in the other lounge. Cavendish Care Home DS0000072774.V375809.R01.S.doc Version 5.2 Page 18 The Registered Manager said that Church services do take place but a recent Regulation unannounced 26 visit which was completed on behalf of the Registered Provider said that they had ceased. Clarity is need on the current situation. We spoke to a number of visitors to the home and they confirmed visiting is not restricted and that the staff make them feel welcome. People who use the service are not able to mange their own finances so this would be undertaken by family or representatives on their behalf. Information about advocacy is provided in the main entrance of the home. We observed in a number of rooms peoples personal belonging on display. We did observe some people being offered choices especially with the meal provision. However this was not always the case as previously mentioned that people are not asked if they would like to wear a ‘bib’ at mealtimes. A brief inspection of the kitchen area took place and the home has been awarded 4 stars from the local Environmental health Department (EH) which is excellent. Records were seen of health and safety checks but records need to be maintained of the type of soups offered and sandwich fillings for each day. Menu boards are on display in both communal areas and this includes the alternatives that are also on offer. In the dining room table cloths and salt and pepper are on the tables for people to help themselves. People are offered a cooked breakfast each day and we observed people having several different options to include a full English cooked breakfast and a boiled egg. This is good practice. On the first day of the inspection as mentioned in the previous outcome group the breakfast was served very late for people and this caused several people to become agitated. The feedback we received is that this is common in this home. We were concerned as it meant people were going from about 8.30pm the previous night until about 10.15 am the following morning without any food. This is poor practice especially for diabetics who required frequent intake of food to help maintain their blood glucose levels. We were also concerned that lunchtime is normally around 12.30pm which means that some people would not be hungry as they were only having their breakfast about 2hours before. We also observed that all the cooked breakfasts are plated on the trolley and covered with a plastic cover, but for people who were in the room being served second their cooked breakfasts were cold. We issued an immediate requirement for this to be rectified and on the following day an extra member of staff was assigned to serve breakfasts form 8am until 10am. The Registered Manager said that this has improved the situation as people are getting their breakfast earlier and hot. On the second day of the inspection we arrived at 10am and the breakfasts had been completed and people appeared a lot less agitated which is excellent. However on the first day of the inspection we noticed that there is limited staff supervision in either communal room during mealtimes and this will need to be reviewed. Cavendish Care Home DS0000072774.V375809.R01.S.doc Version 5.2 Page 19 We observed one member of staff who assisted one person with a meal, she was very patient and told the person about the meal and also gave them time to have a drink with the meal. We did observe one person who was going to be assisted with eating but they were not sitting up enough and we had to ask the Registered Manger to intervene in this case. Cavendish Care Home DS0000072774.V375809.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service and their representatives are able to voice any concerns they might have and have access to a complaints procedure. Systems are in place to help prevent people from possible risk of harm or abuse. EVIDENCE: The home has not received any complaints since their new registration. A copy of the homes complaints procedure is on display. The registered Manager says she encourages relative/representatives of people to speak to the staff if they are unhappy about anything. Prior to this inspection we received some concerns about the care of people who use the service. These have been followed up and any shortfalls have been identified to the Registered Persons. The home has polices in place in relation to whistle blowing and protection of vulnerable people and this policy also includes information about abuse. The home needs to have policies for the management of violence and aggression. The majority of staff have completed the ‘Alerters’ guide training provided by the local County Council and all staff have had in-house training in the protection of adults. The Registered Manager has completed the one day Cavendish Care Home DS0000072774.V375809.R01.S.doc Version 5.2 Page 21 ‘enhanced’ adult protection training provided by the local County Council as well as one other member of staff. No people who use the service have been referred to the local safeguarding unit at the County Council. Cavendish Care Home DS0000072774.V375809.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Cavendish Care home is not a purpose facility but some adaptations have been made to help meet people’s needs. However improvements are needed to the cleanliness and some infection control procedures to make sure people are not put at unnecessary risk. EVIDENCE: A tour of parts of the environment took place with a number of rooms belonging to people viewed. Cavendish Care Home is not a purpose facility however some adaptations have been put in place and these include assisted bathing facilities. As the home is registered to care for people with dementia signage is in place to direct people to the toilets and communal rooms, the toilet doors have all been painted the same colour and downstairs in one of the Cavendish Care Home DS0000072774.V375809.R01.S.doc Version 5.2 Page 23 corridors fixed to the wall is a board with a selection of handles on for people to touch as they walk past. Four new bedrooms have been added to the upstairs and they provide en-suite facilities. We viewed all new rooms with the consent of the people who are using them and one person and their relatives said their room was very comfortable. Two relatives asked if the reception on the Televisions in both communal rooms could be looked at as the reception is not very good and the in rear lounge/dining room they are unable to watch certain channels. Another comment from a relative was that the light bulbs in the upstairs corridors often are not working and they felt this could be dangerous at times as there is no natural light. On entering the home on the first day the entrance area was odorous, we found some other areas that also had odours. The overall standard of cleanliness needs to be improved as there was visible debris on the carpets in people’s rooms and corridors and several toilets required cleaning. On one corridor upstairs excrement was on the carpet and we understand this happened in the night; this also caused the upstairs to become odorous. This was cleaned up by the domestic, but as this happened in the night the night staff should have made some attempt to clean this up as other people could have walked in it. The homes domestic is now off sick and alternative arrangements must be put in place as a matter of urgency. A comment we received from relatives was that when the weather is warm or hot the odours in the home increase especially in the lift. The kitchen area was found to have high standards of cleanliness. We identified some issues that need to be address and they include: 1. The ceiling on the upstairs by the entrance to the lift is leaking water when it rains and it was leaking on the first day of the inspection, 2. Rooms 14 & 15 had their curtains hanging off the hooks 3. Several toilets did not have paper towels for people to dry their hands 4. Odours as mentioned above 5. The door to the communal lounge at the front of the property is propped open with a wedge but the sign on the door says it must be kept shut, this must be checked out with the local Fire Service to make sure it is safe. 6. Cleaning products were left unattended in an upstairs corridor which is unsafe practice. 7. The light in the domestic’s cupboard was not working and we heard a member of staff ask the domestic if they wish to have this cupboard left open, again this is unsafe as cleaning chemicals are stored in this cupboard. 8. We found a ‘shower’ list which had details about what day people should have their shower, this information should not be stored in communal corridors. On the first day of the inspection several people complained that they were cold in the rear lounge/dining room and the front lounge. The Registered Cavendish Care Home DS0000072774.V375809.R01.S.doc Version 5.2 Page 24 Manager put the heating on put it took along time to warm up especially in the rear lounge/dining room. One person told us that they were experiencing problems with the laundry system as they had run out of some of their clothing. This is not good practice as this person was distressed by this. We also saw that in a questionnaire the home had sent out to relatives, one relative had also mentioned concerns about the laundry. The laundry system in the home needs to be reviewed to make sure it is meeting people’s needs. Staff were observed to be using linen skips but on closer inspection we found that on the top of these skips were open bags with soiled continence products, this is unsafe practice as people could put their hands in these and alternative systems must be used. Protective clothing to include gloves and aprons are provided for staff and we observed staff using them. Cavendish Care Home DS0000072774.V375809.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At times there are not enough staff to meet the needs of people who use the service. A training programme is provided for staff to help them gain the skills and knowledge to meet people’s needs however, some training is not always offered prior to a member of staff undertaking that task. EVIDENCE: The duty rotas were viewed with the Registered Manager. We had concerns about the staffing levels on the day of the inspection due to the fact people did not have their breakfast till mid morning and that whilst the staff were assisting people with personal care there was limited supervision of other people. The day after the inspection an additional member of staff had been appointed from 8am until 10am to serve breakfasts. When we looked at the staffing numbers for the afternoon shift it is normally 4 members of care staff but on some occasions a member of staff finishes at 6 or 7pm which then reduces the numbers of staff. A review of the staffing numbers are required as care staff also undertake other tasks that are not related to care and these include, laundry, some cleaning as the domestic finishes work at 2pm and only works week days and serving the evening meal. The layout of the building must be taken into account and the supervision of the communal area. We Cavendish Care Home DS0000072774.V375809.R01.S.doc Version 5.2 Page 26 were also concerned that at meal times there is again limited supervision of communal areas as care staff are serving the meal and assisting people who are in their rooms. One person said “the staff are good but I have difficultly understanding some of the staff”. Relatives we spoke to said the staff are good and hard working. The Registered Manager said the staff work well together and they will always try to cover any shifts that are vacant. Staff spoken with said it is a nice place to work and the staff are a good team. The Registered manager confirmed that the numbers of staff who have an NVQ 2 or above in Health and Social Care or who are due to start this training is the same as what is on the AQAA. Therefore the home exceeds the recommended 50 of care staff with NVQ 2 or above in Health and Social Care which is excellent. We looked at two staff recruitment files of staff that have recently started work at the home. We viewed the Criminal Records Bureau disclosures (CRB) and POVAfirst checks at the Registered Providers office. Both staff had all the required checks in place except both did not have a full employment history therefore the gaps had not been explored. Also one member of staff only had one written reference returned prior to them starting work. The Registered Manager explained the reason for this; however the Care Home Regulations 2001 state that 2 written references must be in place prior to the member of staff starting work. A copy of a work permit is required for one member of staff. We saw evidence in the staff recruitment files that they have received in house induction training. The Registered Provider has plans to change this programme to an external training agency. We saw a number of training certificates for in house training but we did not see any record of moving and handling training for new staff. The registered manager did say they have plans in place for this training. Dementia training has been provided by external agencies and the vast majority of staff will have completed the ‘dementia day one and day two’ training shortly with the local County Council. The Care Home Support team are also providing training for staff in dementia and challenging behaviour. On the second day of the inspection continence training was being provided by the Primary Care Trust. We saw records for in house training in infection control, fire, and food hygiene; however we would recommend that some external training is provided in these areas. Staff who are not first aiders would benefit from some first aid awareness training. Staff confirmed that training is provided. Cavendish Care Home DS0000072774.V375809.R01.S.doc Version 5.2 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 & 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of this service and their quality assurance system they have in place has not identified the shortfalls in provision. EVIDENCE: The Registered Manager has been working at this home for about 16 years and has many years experience in looking after older people. She keeps herself up to date with training and we saw her training record. She has not as yet undertaken the required management course and is now considering this again. Cavendish Care Home DS0000072774.V375809.R01.S.doc Version 5.2 Page 28 We received the homes Annual Quality Assurance Assessment (AQAA) on time. Despite the information provided being brief it did contain what the home feels they do well and any areas they are looking to improve on in the next 12 months. The homes list of policies had a number of omissions and the Registered Manager confirmed at the inspection that they did not have these in place. These included moving and handling management of aggression and first aid. This needs to be rectified as a matter of urgency. At this inspection we identified a number of shortfalls in the service and these must now be addressed to make sure people’s needs are met. We looked at the systems the home has in place to monitor it progress. Regulation 26 visits where the Registered Provider or a representative on their behalf visits the home monthly unannounced and undertakes an audit are taking place. However these are not stored at the home. No shortfalls had been identified in these visits. Due to the shortfalls we identified at this inspection copies of these visits must be sent to us at Newcastle. Audits take place at frequent intervals and records were seen of these. Questionnaires have been sent out to relatives and 4 have been returned. Meetings take place for people who use the service and staff but we did not view the minutes of these. The home was able to demonstrate they have a safe system in place for the management of people’s monies. The Registered Manager said she needs to implement a system for staff supervision as only two members of staff have had a session this year and records confirmed this. The Registered Manager did confirm that staff do receive yearly appraisals. At this inspection we issued an immediate requirement under Regulation 37 of the Care home Regulations as we had not been informed of a number of incidents involving people who use the service. The AQAA contained some information about the servicing of certain equipment in the home and other records were seen at the inspection. Records relating to monthly water temperature checks were seen. A fire risk assessment is in place and each person has in their care records an evacuation procedure. Checking of fire equipment is also taking place and records were also seen of these. Cavendish Care Home DS0000072774.V375809.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 1 STAFFING Standard No Score 27 2 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 1 2 3 Cavendish Care Home DS0000072774.V375809.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The registered persons must make sure that people who use the service have care plans in place for all their assessed needs. This will help to make sure that staff have clear directions to follow when caring for people who use the service. The registered persons must make sure that the home is conducted in such a way so as to promote and make proper provision for the health and welfare of people living at the home. This specifically relates to peoples needs not being met as breakfast was not served until 10.15am onwards, peoples positions were not alleviated for pressure and people not being taken to the toilet. An immediate requirement was issued on the first day of the inspection. The registered persons must make sure that systems are put into place to monitor people’s nutritional needs. This includes DS0000072774.V375809.R01.S.doc Timescale for action 30/07/09 2. OP8 12(1) 06/06/09 3. OP8 12(1) 30/06/09 Cavendish Care Home Version 5.2 Page 31 monitoring people’s weight loss and taking actions necessary to address it. This will help to make sure peoples health needs are monitored and external health professionals contacted for advice and support. The registered persons must make sure that people who use the service and have diabetes are being monitored and external advice from health professionals is obtained and actioned. This will help to make sure peoples health needs are monitored and external health professionals contacted for advice and support. The registered person must make sure that people who are cared for in bed are not put at risk by placing a chair next to the bed and other methods are used to prevent them from falling. This will help to prevent people from being put at unnecessary risk of possible harm. The registered persons must make sure that all prescribed creams are stored securely at all times. This will help to prevent people who use the service from being put at unnecessary risk. The registered person must make sure that people who use the service are treated with respect and their privacy and dignity is maintained. This is with particular reference to the use of seat covers in communal areas and ‘bibs’ with DS0000072774.V375809.R01.S.doc 4. OP8 12(1) 30/06/09 5. OP8 13(4c) 06/06/09 6. OP9 13(2) 06/06/09 7. OP10 12(4) 06/06/09 Cavendish Care Home Version 5.2 Page 32 8. OP19 23(2) out asking people if they want to wear one. The registered persons must address the maintenance issues identified in this report. This will help to make sure people live in a comfortable and safe environment. The registered persons must make sure that suitable arrangements are in place for maintaining satisfactory standards of hygiene in the home. This will help to make sure people live in a clean and comfortable environment. The registered persons must address the odours identified at this inspection. This will help to make sure people live in a clean, hygiene and comfortable environment. The registered person must review their staffing arrangements to make sure the needs of people who use the service are being met. A record of this review must be maintained. The registered person must make sure that all the required recruitment checks take place prior to a new member of staff starting work at the home. This will help to safeguard people who use the service. The registered person must make sure that staff receive training in the tasks they are to perform. This is with particular reference to moving and handling and first aid awareness. DS0000072774.V375809.R01.S.doc 09/09/09 9. OP26 16 06/06/09 10. OP26 16 20/06/09 11. OP27 18 20/06/09 12. OP29 19 30/06/09 13. OP30 18 30/07/09 Cavendish Care Home Version 5.2 Page 33 This will help to make sure people who use the service are having their needs met and they are not put at unnecessary risk. 14. OP37 37 The registered persons shall give notice to us without delay of any occurrence under this regulation. An immediate requirement was issued on the first day of the inspection. 06/06/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP7 OP9 OP9 OP9 Good Practice Recommendations Words like ‘regularly’ and ‘adequate’ should not be used in care records as staff require clear directions to follow when meeting peoples needs. Hand written entries should be checked and signed by a second member of staff for safety. The home needs to make sure medications are stored at the recommended manufacturers’ temperature and maintain records to demonstrate this. The home should now incorporate the Mental Capacity Act 2005 guidance into the medication process for example asking people where they would like their medications administered. When ‘prn’ or as required medications are administered the actual time should be recorded to make sure they are not given too close together. The home should review their laundry arrangements to make sure they are meeting the needs of people who use the service. The home should consider using external training as well as in house training for mandatory subjects to include food hygiene, moving and handling and infection control. 5. 6. 7. OP9 OP26 OP30 Cavendish Care Home DS0000072774.V375809.R01.S.doc Version 5.2 Page 34 Care Quality Commission South West PO Box 1251 Newcastle Upon Tyne NE99 5AN National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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