Inspection on 25/08/05 for Cerne Abbas Care Home

This inspection was carried out on 25th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cerne Abbas Care Home 26/06/08

Cerne Abbas Care Home 26/03/08

Cerne Abbas Care Home 14/06/07

Cerne Abbas Care Home 11/05/06

Cerne Abbas Care Home 24/01/06

Cerne Abbas Care Home 24/01/06

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

CARE HOME ADULTS 18-65 Cerne Abbas Care Home Cerne Abbas Dorchester Dorset DT2 7AL Lead Inspector Amanda Porter Unannounced 25 August 2005 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Cerne Abbas Care Home D55 S65834 Cerne Abbas Care Home V254995 250805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Cerne Abbas Care Home Address Cerne Abbas, Dorchester, Dorset, DT2 7AL 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) 01300 341008 01300 341008 Ashbourne (Eton) Limited Care Home with Nursing 71 Category(ies) of DE(E) - 53 registration, with number of places Cerne Abbas Care Home D55 S65834 Cerne Abbas Care Home V254995 250805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: The Cloisters unit may accommodate a maximum of 18 younger adults with acquired brain injury, or Huntington`s Disease. To provide care for four named persons (as known to CSCI) with mental disorder, over the age of 65 years. Service users over the age of 65 years in the category DE(E) may only be accommodated in the Older Person`s Unit. One named person (as known to CSCI) under the age of 65 years may be accommodated to receive care. Date of last inspection 21 February 2005 Brief Description of the Service: Cerne Abbas Care Centre is situated on the outskirts of the village of Cerne Abbas, in West Dorest and is within walking distance of the village amenities such as a post office, church, pubs and tea rooms. Car parking for visitors is provided at the rear of the home. The home is registered to provide specilaist nursing care for 53 older people with dementia and 18 younger adults who have acquired brain injury, or Huntingtons disease. This report relates to the younger adults unit. The home provides nursing and care staff on a 24-hour basis, and catering, domestic and maintenance staff are on duty thoughout the waking day. In addition to the nursing, personal care and accommodation provided, the scale of charges for the home includes the provision of social activities, catering for all meals, and laundry and housekeeping services. The part of the home deliering care the the younger adults is Cloisters Unit, situated on the first floor. One working lift provides access to the unit. An electronic number keypad is used on the door leading to Cloisters. Cerne Abbas Care Centre is owned by Ashbourne Healthcare, who operate a number of care services throughout England and Wales. At the time of inspection the home is without a Registered Manager. Cerne Abbas Care Home D55 S65834 Cerne Abbas Care Home V254995 250805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over the day of the 25th August 2005 and took two inspectors four and a half hours each. The purpose of the inspection was to review the requirement and recommendations made in the last report and to assess key standards. Four residents and five members of staff were spoken with and asked their views on the home. Some documentation was reviewed, including care files, accident records. A tour of the premises was undertaken. What the service does well: What has improved since the last inspection? What they could do better: As a result of this inspection a total of nine requirements and five recommendations have been made. Two of these recommendations have been brought forward from the previous report. The home should give consideration to a way in which residents on the Cloisters Unit can air their views and participate in decisions made about the running of the unit. There is little access to leisure and educational activities on the unit. The home needs to provide access to further education and training for the residents who wish to be involved and develop an appropriate activities programme. The choice of food was limited. The menu was not readily available to residents, who were unaware of what their next meal would be. Cerne Abbas Care Home D55 S65834 Cerne Abbas Care Home V254995 250805 Stage 4.doc Version 1.40 Page 6 Records did not clearly detail resident’s preferences and how they wished to be supported. Emotional needs were not addressed in depth, which resulted in some residents being quite frustrated. Some environmental issues need to be addressed, which include: • Repair to a large hole in one wall in the smoking room • Repair of some radiator covers • General cleanliness of the unit and the kitchen • Repair or replacement of laundry bins • Redecoration of second lounge, which had a dark and dull décor, with much of the paint scuffed • Installation of heating into all en-suit facilities. • Repair work to the kitchen to comply with the environmental health officer’s report from November 2004 • Repair or replacement of a fire door. At the previous inspection a recommendation was made that to aid effective quality assurance, feedback should be sought from the residents. This was not assessed during this inspection and the recommendation has been brought forward into this report. 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. Cerne Abbas Care Home D55 S65834 Cerne Abbas Care Home V254995 250805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Cerne Abbas Care Home D55 S65834 Cerne Abbas Care Home V254995 250805 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed during this inspection. EVIDENCE: Cerne Abbas Care Home D55 S65834 Cerne Abbas Care Home V254995 250805 Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 9 Generally individual plans of care reflect changing needs and goals ensuring that residents have most of the care they need. Risk management systems support residents in achieving a degree of independence. EVIDENCE: The care documentation for five residents was reviewed. Each file contained a written plan detailing all aspects of care. There was evidence that the residents and/or a representative had been included in drawing up and reviewing the plan. Files also showed that residents were not prevented from taking reasonable risks. Risk assessment had been clearly documented and the relevant information taken from them was then used in care plans. In the absence of a manager or the senior sister on the unit at the time of inspection Standard 8 was not assessed but will be reviewed at the next inspection. The recommendation made in the last report has been brought forward into this one. Cerne Abbas Care Home D55 S65834 Cerne Abbas Care Home V254995 250805 Stage 4.doc Version 1.40 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14 & 17. The social and recreational and educational needs of the service users are not wholly satisfied, which results in some residents being bored and under stimulated. The meals in this home are poor with little evidence that residents are offered either quality meals or choice. EVIDENCE: The home employs two enthusiastic activities co-ordinators, who work a total of sixty-one hours per week. This was time spent between the older persons units and the younger persons unit. During this inspection there were no organised activities on Cloisters. Although there was a weekly programme of activities for the whole home it was not clear when these were specifically for Cloisters. Residents and staff were asked what would be happening during the course of the day as far as activities were concerned but nobody knew. Residents said that at times they were bored. Since the last inspection the activities coordinators were able to hire one taxi a week for trips for the younger adults. Residents said that they did not think Cerne Abbas Care Home D55 S65834 Cerne Abbas Care Home V254995 250805 Stage 4.doc Version 1.40 Page 11 this was sufficient and would like to have the opportunity to get out and about more. At the last inspection one resident had expressed a wish to be involved in some educational programmes locally but since then little progress had been made to ensure that these opportunities were made available and maintained. A record of activities was held for each resident by the activities coordinators but they were not accessible to the care staff therefore activities were not continued by them. During the course of the morning residents and staff were asked if they knew what was for lunch. Even though there were four weeks of menu on display no one could identify what was expected. Asked whether they liked the food served residents said “Sometimes.” “Yes, I like the food.” A tour of the kitchen area was undertaken. The second cook and an agency kitchen assistant were on duty. They were under considerable pressure to produce approximately a hundred meals for lunchtime, which included meals for residents, visitors and staff, and contend with all the washing up for each meal. At the time of the visit, which was late morning, the kitchen assistant was still doing the washing up from breakfast time. The cook confirmed that residents did not have much choice of menu unless prior arrangements were made. The budgetary allowance for the provision of food is very meagre at £18 per week per resident. Staff and visitors meals provided are included in this amount. Cerne Abbas Care Home D55 S65834 Cerne Abbas Care Home V254995 250805 Stage 4.doc Version 1.40 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 & 19. Care documentation did not clearly detail how residents prefer and require to be supported. Emotional health needs were not addressed in depth, which resulted in some residents feeling frustrated. EVIDENCE: The care files seen gave some detail of how physical care was to be given to residents based on specific assessments, such as: • Moving and handling • Ryden aggression scale • Nutrition, including weight charts • Activities of daily living • The emotional needs of residents were not always documented and some residents expressed a level of frustration about this, which was manifested in both physical and verbal aggression. Records were seen with regard physical aggression, which resulted in a large hole in one wall of the smoking room; resident to resident aggression and resident to staff aggression. Cerne Abbas Care Home D55 S65834 Cerne Abbas Care Home V254995 250805 Stage 4.doc Version 1.40 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed during this inspection. EVIDENCE: Cerne Abbas Care Home D55 S65834 Cerne Abbas Care Home V254995 250805 Stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 27 & 30. The standard of décor within Cloisters is poor with little evidence of improvement through maintenance or future planning. The overall quality of the furnishing and fittings is poor and potentially dangerous placing residents and visitors at risk of injury or harm. The home is not clean and most areas have an odour of stale urine, which is offensive. This home does not, therefore, present as a homely and comfortable environment for residents. EVIDENCE: Cloisters Unit has a main lounge/dining area, which leads out onto a courtyard, a smoking room and one further lounge. It was noted that the walls under the windows in the main lounge/dining area were dirty. When walking through the unit it was noted that some carpets were “sticky”. Some areas had the odour of stale urine. The kitchen area was not clean and the cook confirmed there was insufficient time to undertake the cleaning regimes necessary in a kitchen that size. A considerable amount of debris was seen under the cooker. Cerne Abbas Care Home D55 S65834 Cerne Abbas Care Home V254995 250805 Stage 4.doc Version 1.40 Page 15 There was a large hole in one wall in the smoking room. The other lounge looked dark and dull and was in need of redecorating and refurbishment. The guard on one large radiator was broken. Most of the bedrooms were seen. One had not had an occupant for several weeks but had not been cleaned. Bed linen had not been changed and there was a collection of nursing equipment and used toiletries left out. Most bedrooms had en-suite facilities but some were unheated. Some bedrooms were personalised with pictures, items of furniture and a variety of mementos. Some residents had music centres and computers. Specialised beds and moving and handling equipment was provided for the more disabled residents cared for. The laundry room was seen. The home employs designated staff to undertake the laundry duties. There were separate areas for clean and dirty laundry. However, to remove the clean and take it back to the unit it had to be brought through the dirty area. At the time of inspection the washing machines and tumble driers were in full working order, although some laundry bins were broken. Some new linen had been recently purchased by the home. Cerne Abbas Care Home D55 S65834 Cerne Abbas Care Home V254995 250805 Stage 4.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed during this inspection. EVIDENCE: Cerne Abbas Care Home D55 S65834 Cerne Abbas Care Home V254995 250805 Stage 4.doc Version 1.40 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 Practises within the home do not promote and safeguard the health and safety of residents, leaving them potentially at risk of harm. EVIDENCE: Touring the premises a fire door leading between Cloisters and Courtyard Units was seen to have a hole in it, where a keypad had been removed. This compromised its efficiency as a fire door. Some of the requirements made by the environmental health officer in a report dated 29th November 2004 had not been complied with. The potato peeler was still in a bad state of repair and the pipe work to the dishwasher was leaking on to the floor and could have caused injury to staff through slipping. Due to the fact that the home had no manager at the time of inspection and that the senior nurse for Cloisters Unit was not on duty standard 39, relating to quality assurance, was not assessed. The recommendation made in the last report has been brought forward in to this one and this standard will be fully assessed at the next inspection. Cerne Abbas Care Home D55 S65834 Cerne Abbas Care Home V254995 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 Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 x x 1 x x 2 Standard No 11 12 13 14 15 16 17 x 2 x 1 x x 1 Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cerne Abbas Care Home Score 2 1 x x Standard No 37 38 39 40 41 42 43 Score x x x x x 1 x D55 S65834 Cerne Abbas Care Home V254995 250805 Stage 4.doc Version 1.40 Page 19 NO 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 YA14 Regulation 16(2)(n) Requirement A programme of activities must be developed to ensure that all residents have the opportunity to engage in appropriate leisure acitivities. The registered person must ensure that residents are provided with a choice of suitable, wholesome and nutritious food. The emotional needs of the residents must be assessed and where needs are identified a clear care plan must be written and implemented. The home must be clean and free from unpleasant odours. The large hole in one wall of the smoking room must be repaired. All broken radiator covers must be repaired or replaced. Suitable heating must be provided in all en-suite facilities. The home must comply with the requirements issued by the environmental health officer in their report dated 29/11/04. All fire doors must be fully operational. Timescale for action 25/11/05 2. YA17 16(2)(i) 25/11/05 3. YA19 12(1) 25/11/05 4. 5. 6. 7. 8. YA24 YA24 YA24 YA27 YA42 23(2)(d) 23(2)(b) 23(2)(b) 23(2)(p) 23(5) 25/11/05 25/11/05 25/11/05 25/11/05 25/11/05 9. YA42 23(4) 25/11/05 Cerne Abbas Care Home D55 S65834 Cerne Abbas Care Home V254995 250805 Stage 4.doc Version 1.40 Page 20 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 YA8 Good Practice Recommendations The home should give consideration to a forum for residents on Cloisters Unit to air their views and participate in decisions made about the running of the unit.(This recommendation has been brought forward from the previous report.) All residents should have access to further education and training. The home should clearly document each residents preferences as to the way in which the receive personal support. All laundry equipment, including laundry bins, should be in good working order. To aid effective quality assurance the registered person should seek feedback from the residents. 2. 3. 4. 5. YA12 YA18 YA30 YA39 Cerne Abbas Care Home D55 S65834 Cerne Abbas Care Home V254995 250805 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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