CARE HOMES FOR OLDER PEOPLE
Cherry Garden Nursing Home. Breadcroft Lane Littlewick Green Maidenhead Berkshire SL6 3QF Lead Inspector
Mrs Rhian Williams-Flew Unannounced Inspection 1st December 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cherry Garden Nursing Home. DS0000010980.V269532.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cherry Garden Nursing Home. DS0000010980.V269532.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Cherry Garden Nursing Home. Address Breadcroft Lane Littlewick Green Maidenhead Berkshire SL6 3QF 01628 825033 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) Amberbrook Limited Mrs Gillian May Elston Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Cherry Garden Nursing Home. DS0000010980.V269532.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9th June 2005 Brief Description of the Service: Cherry Gardens is a care home with nursing registered for 36 older people. The home is not registered to admit people with dementia. The home is a large property in a rural location. Access to the property is best achieved in a motor vehicle. The accommodation is on two floors. All of the communal areas are downstairs; these are spacious and overlook the gardens of the home. Eight of the rooms are used for double occupancy. This home was registered prior to 31 March 2002 therefore there are rooms in the home that are smaller than the present standards. There are seven single rooms under 10 square metres. Cherry Garden Nursing Home. DS0000010980.V269532.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection occurring between 10.00 and 16.30 hours. The Registered Manager was present throughout the inspection. This report should be read in conjunction with the report of the inspection completed on 9 June 2005 in order that a complete overview of the home, with regard to the key standards inspected during both inspections. During this inspection a partial tour of the home was completed to review that previous requirements had been met; five residents were spoken with; three members of staff were spoken with and a sample of records kept in the care home were reviewed. An immediate requirement was issued with regard to the recruitment procedures in the home (ref standard 29). What the service does well: What has improved since the last inspection?
All the previous requirements have been met. The most significant change has been a complete review and revision of the care planning process and the implementation of new care plan records. The Registered Manager and nursing staff have clearly worked hard to review all of the residents needs and develop the new records. It was evident that the change has improved the quality of record-keeping and has greatly assisted in the ease in which information can be accessed. The members of staff spoken with had found the
Cherry Garden Nursing Home. DS0000010980.V269532.R01.S.doc Version 5.0 Page 6 task challenging but now felt that the new system was much improved and ensured that the care plan needs of the residents were up-to-date, accurate and easy to reference. An occupational therapist has completed a full report to evaluate whether the home has the correct environmental adaptations and disability equipment to meet the needs of its residents. This was seen and it was noted that the comments and recommendations that have been made are pragmatic and could greatly assist in meeting the needs of residents. The Registered Manager is still awaiting confirmation from the Responsible Individual, Mr Nanji, as to whether the comments and recommendations of the report will be implemented. A requirement has been made for the Responsible Individual and the Registered Manager to review the recommendations and provide a timescale of action as to when the recommendations will be carried out. The quality assurance and quality monitoring systems have continued to develop and have been implemented. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cherry Garden Nursing Home. DS0000010980.V269532.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cherry Garden Nursing Home. DS0000010980.V269532.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected on this occasion. EVIDENCE: These standards were not inspected on this occasion. Cherry Garden Nursing Home. DS0000010980.V269532.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7&8 The new care plan format being used in the home has ensured that information that is relevant to the resident’s needs and wishes is clearly recorded and easily referenced. EVIDENCE: A review of a random selection of care plans was undertaken. The care plans have been completely revised and rewritten and provide good, clear information about the needs of the residents and their wishes. The information is being regularly reviewed and updated. The Registered Manager acknowledges that the new care plan format is easier for staff to use and ensures that the details of the residents needs are clearly documented. The registered nurses also confirmed that their efforts had been rewarded by having a much better care plan format in place. From the evidence seen it was clear that the staff had embraced the changes wholeheartedly. It was also clear that the residents are being included in their care planning (where this is possible). A previous requirement has been met to ensure that the home had proper photographic equipment in order to record the management and treatment of
Cherry Garden Nursing Home. DS0000010980.V269532.R01.S.doc Version 5.0 Page 10 wounds. A requirement to address the one deficit of correct labelling on medication has also been addressed. Cherry Garden Nursing Home. DS0000010980.V269532.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 The inclusion of the Cook in conversing with the residents about their likes and dislikes of food and her involvement in the serving of food and the gathering of feedback at the end of the meal is proving to be very successful for both residents and staff in the home. EVIDENCE: The Cook was spoken with and the menu selections reviewed. Additionally, the serving of the midday meal was observed and residents were asked their views of the meal. The Cook has completed her NVQ 2 and has clearly been enthused by her learning as, in collaboration with the Registered Manager changes had been made. These include, the Cook being the person who asks the residents their preferred choice of menu each day, she also serves the main meals so that she observes whether people have enjoyed their preferences or whether their appetite is diminishing, she is also available to take direct feedback from the resident group as to their satisfaction or otherwise of the menu presented. This is clearly proving to be an effective arrangement that is very inclusive of the Cook in meeting the needs of the residents. The Cook has also developed new menus and a new way of presenting the information. She has also devised a recipe folder, which details the ingredients of each of the main items on the menu so that residents and staff can use it as a reference book when
Cherry Garden Nursing Home. DS0000010980.V269532.R01.S.doc Version 5.0 Page 12 they have a query as to the ingredients of a specific meal. The comments from the residents when asked about their menu choices and the presentation of food were positive. Cherry Garden Nursing Home. DS0000010980.V269532.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The Registered Manager has ensured that all members of staff have received training in the Protection of Vulnerable Adults. EVIDENCE: The Registered Manager has ensured that members of staff have received training in the Protection of Vulnerable Adults and are familiar with the local procedures. The home does have clear policies and procedures with regard to the Protection of Vulnerable Adults including any monies or financial affairs. The Registered Manager confirmed that she understands and knows when to report members of staff to the Protection of Vulnerable Adults register, if it is proven that they are unsuitable to work with vulnerable adults. Cherry Garden Nursing Home. DS0000010980.V269532.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 25 & 26 The environment of this home is clean, comfortable and homely. Implementation of the recent occupational therapy report regarding the home having the correct environmental adaptations and disability equipment to meet the needs of the residents should occur. EVIDENCE: Three previous requirements have been met. Carpeting in three residents rooms have been replaced as they presented a health and safety risk with regard to being trip hazards. The radiators in one of the large lounges are now working effectively. The sluice room has been thoroughly cleaned and is now included on the cleaning schedule. In addition, the sluice has been replaced. The care home was very clean and tidy. Residents commented that the domestic staff, work hard to keep the home spick and span. Cherry Garden Nursing Home. DS0000010980.V269532.R01.S.doc Version 5.0 Page 15 An occupational therapist has completed a full report to evaluate whether the home has the correct environmental adaptations and disability equipment to meet the needs of its residents. This was seen and it was noted that the comments and recommendations that have been made are pragmatic and could greatly assist in meeting the needs of residents. The Registered Manager is still awaiting confirmation from the Responsible Individual, Mr Nanji, as to whether the comments and recommendations of the report will be implemented. As this document informs the quality assurance of the care home the Registered Manager may wish to consider sharing information with the residents and/or their carers and advocates to canvass their views on the comments and recommendations of the report. The Occupational Therapist report should also be reviewed with reference to the current Disability legislation. Cherry Garden Nursing Home. DS0000010980.V269532.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 & 30 This home has not had sufficiently robust procedures in place to ensure that its’ staff have had full Criminal Records Bureau (CRB) checks and Protection of Vulnerable Adults (POVA) checks before commencing work in the care home. This is a significant deficit that has required immediate action by the home. The Registered Manager does ensure that all members of staff receive regular training including, the mandatory training required. EVIDENCE: The recruitment records of three members of staff were inspected. Evidence could not be found to demonstrate that new members of staff are only confirmed in post following the completion of a satisfactory check of the Protection of Vulnerable Adults (POVA) register (by using, if necessary the POVA first system) and a satisfactory Criminal Records Bureau (CRB) check. It became apparent during the inspection that two members of staff (who were in the care home for training but were not providing personal care) had not had confirmation of satisfactory CRB or POVA check. This should not have occurred. An immediate requirement was made to remedy the situation found, and to remedy the deficits in the care homes policies and procedures. Subsequently, confirmation has been received in writing from the Registered Manager to say, all members of staff presently working in the care home do have the appropriate checks in place. It has also been confirmed that the two members of staff identified during the inspection were sent on immediate leave awaiting confirmation of their CRB and POVA status. It has been
Cherry Garden Nursing Home. DS0000010980.V269532.R01.S.doc Version 5.0 Page 17 recommended to the Registered Manager that she review the CRB and POVA guidance available on the CSCI website. This should assist in addressing the requirement. The home has also not had a policy and procedure in place to permit (in exceptional circumstances) members of staff to work in the home having only received a clear “POVA first” check. This will need to be addressed. It is imperative that there are robust procedures in place within the care home with regard to the recruitment and deployment of staff. This is the registered persons responsibility. Cherry Garden Nursing Home. DS0000010980.V269532.R01.S.doc Version 5.0 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 The Registered Manager and staff of the home are focused in ensuring that the home is run to meet the needs and wishes of the residents who live there. The Registered Manager is continuing to develop quality assurance and quality monitoring systems to verify whether the home is able to meet the stated needs of the residents. She and her staff strive to ensure that the quality of care delivered is good and what people want. EVIDENCE: The care home has continued to develop its quality assurance and quality monitoring systems. A survey of carers views and opinions has recently been analysed and the Registered Manager is developing an action plan to implement some of the changes and suggestions. The survey has also highlighted for the manager areas where the survey could be developed further. There are quality audit mechanisms being developed to ensure that care plans are randomly reviewed as well as, audits of pharmacy,
Cherry Garden Nursing Home. DS0000010980.V269532.R01.S.doc Version 5.0 Page 19 housekeeping, catering, activities etc. In discussion with the residents spoken with it was clear that they felt their needs were well met and their views, opinions and preferences were asked and listened to. Cherry Garden Nursing Home. DS0000010980.V269532.R01.S.doc Version 5.0 Page 20 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 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X 2 X X 3 3 STAFFING Standard No Score 27 X 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X X Cherry Garden Nursing Home. DS0000010980.V269532.R01.S.doc Version 5.0 Page 21 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 OP22 Regulation 23(2)(n) Requirement For the Responsible Individual and the Registered Manager to review the recommendations of the Occupational Therapy report (that has been produced following a review of the aids and adaptations in the home) and provide a timescale of actions as to when the recommendations will be carried out. The Responsible Individual and the Registered Manager must ensure that there are robust recruitment policies and procedures in place to protect the residents who live in the home. There must be evidence in the care home that members of staff are recruited in accordance with the regulations. Timescale for action 31/01/06 2. OP29 17(Sch 4) 19(Sch 2) 01/12/05 Cherry Garden Nursing Home. DS0000010980.V269532.R01.S.doc Version 5.0 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cherry Garden Nursing Home. DS0000010980.V269532.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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