CARE HOMES FOR OLDER PEOPLE
Cherry Hinton Nursing Home 369 Cherry Hinton Road Cambridge Cambridgeshire CB1 4DH Lead Inspector
Nicky Hone Key Unannounced Inspection 11th May 2006 10:30 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 Hinton Nursing Home DS0000024283.V291772.R01.S.doc Version 5.1 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 Hinton Nursing Home DS0000024283.V291772.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Cherry Hinton Nursing Home Address 369 Cherry Hinton Road Cambridge Cambridgeshire CB1 4DH 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) 01223 210071 01223 413572 Rockley Dene Homes Limited Mrs Doris Bater Care Home 40 Category(ies) of Dementia - over 65 years of age (20), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (20), Old age, not falling within any other category (20) Cherry Hinton Nursing Home DS0000024283.V291772.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 7th September 2005 Brief Description of the Service: Situated in a residential area on the south-eastern outskirts of the city of Cambridge, Cherry Hinton Nursing home was purpose-built to accommodate forty service users. The home has three floors, connected by a lift and stairs. The kitchen, store rooms and staff facilities are on the top floor. Nursing care is offered on the middle floor, and the ground floor accommodates older people with dementia. Most of the bedrooms are single rooms and all have ensuite facilities. There are lounge and dining areas on both floors, as well as bathrooms and offices. There is a good size parking area to one side of the building, and attractive, enclosed gardens to the other side and at the back. Cherry Hinton Road is one of the main roads into the city centre, which is about a ten minute drive away. Cambridge offers a range of facilities and leisure activities such as shops, restaurants, cinemas, theatres, swimming pools and a bowling alley. There is a regular bus service passing the home and taxis are available at all times. The railway station, with a good train service to London and the Midlands, is within a five minute drive and major roads such as the M11 and A14 are easily accessible. On the day of the inspection the manager said the fees ranged from £530 to £775 per week. Copies of CSCI inspection reports are on display in the entrance hall and in the upstairs corridor, and a copy is given to anyone who asks for one. Cherry Hinton Nursing Home DS0000024283.V291772.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was carried out by two inspectors who made a tour of the building, spoke to service users, staff and a relative, inspected documents and spent time with the manager. At the time of the inspection there were several vacant rooms. New service users were being admitted to the home that day and the following day. The full inspection before this one was carried out on 07/09/05. An additional inspection to check compliance with the requirements made in September was carried out on 26/01/06. Some of the timescales for meeting the requirements were extended. A further additional inspection was carried out on 23/03/06 when it was considered that the majority of the requirements had been partly but not fully met, so some timescales were extended again. An inspection by the CSCI pharmacist of all matters to do with medicines was carried out on 05/10/05. What the service does well:
From observation, and discussion with service users and relatives, as well as from written feedback given to the home, it is clear that the service offered at Cherry Hinton Nursing Home is appreciated and considered to be of high quality. One service user said “I can’t fault it at all. They’re all very good and kind”. On the day of the inspection a relative said “the home is great, always friendly and I can visit whenever I want. No complaints”. Following the inspection, the company forwarded to CSCI copies of several thank you letters from relatives of former service users. One person wrote “ thank you all so much for the endless care and kindness you gave mum, and also us, her family…..she had first class nursing care…..the home was always so welcoming and homely”. Detailed assessments are carried out before new service users are admitted so that the home knows how service users want their needs to be met, and care plans are put in place. Service users are seen when needed by other health professionals, such as the dietician, chiropodist, optician and dentist, and most of the matters to do with medicines are carried out correctly. Service users can choose how they want to lead their lives, including what time they get up and go to bed, what food they eat, where they eat their meals and what they do during the day. Activities and outings are arranged to keep people occupied and visitors are welcome at any time. Service users and their relatives know who to talk to if they wish to complain.
Cherry Hinton Nursing Home DS0000024283.V291772.R01.S.doc Version 5.1 Page 6 On the whole, the building is well-maintained, clean, comfortably furnished and homely. The enclosed gardens at the side and rear of the home offer a pleasant, sheltered space for service users to sit. Bedrooms for new service users had been made attractive and welcoming, with a gift for each person. The number and skill mix of staff is adequate, recruitment procedures are good, and staff undertake a range of training courses. The home has a number of methods for getting other people’s views about the service that is offered, and the inspectors found no health and safety issues. What has improved since the last inspection? 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 Hinton Nursing Home DS0000024283.V291772.R01.S.doc Version 5.1 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 Hinton Nursing Home DS0000024283.V291772.R01.S.doc Version 5.1 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): 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments are carried out so that service users know the home can meet their needs. EVIDENCE: Records of information kept about four service users were checked. All four files contained assessment information that had been completed before each person was admitted. There was also a note on each file that a letter had been sent to the person confirming that the home would be able to meet their needs. This home does not offer intermediate care. Cherry Hinton Nursing Home DS0000024283.V291772.R01.S.doc Version 5.1 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, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care planning has improved and healthcare needs are met. Some lack of personal care and the way care plans are stored result in service users’ privacy, dignity and confidentiality not always being upheld. EVIDENCE: The care planning at this home has improved since the previous inspection. A score of 2 will be given for this standard to indicate that there has been improvement, but that there is still more work needed on these. There was a series of plans for each aspect of the care needed by each person on all four files that were looked at. The care planning system involves a series of individual plans relating to each identified need, for example ‘personal hygiene’, ‘dressing’, ‘eating and drinking’, ‘mobility’ and so on. At the time of the inspection staff had decided to only complete a plan if there was a need, so that, for example, one person had no plan relating to dressing because she was able to do that herself. The inspectors asked the manager to consider whether this might lead to an emphasis on what a person cannot do, rather
Cherry Hinton Nursing Home DS0000024283.V291772.R01.S.doc Version 5.1 Page 10 than highlighting what they can do, which would encourage independence, and would encourage service users to maintain the skills they have. Some ‘aims and objectives’ on the plans were instructions. It was good to see that the majority of the documents were signed and dated. Some cross-referencing between care plans could be improved. For example, there was information on one person’s mobility plan which gave advice on diet for osteoporosis, but this information was not included on the nutrition care plan. There was evidence that the plans are reviewed each month, and evidence on one of the files that the care plan had been agreed with the service user’s relative. Daily recording is done for each person twice a day and is satisfactory, giving a good picture of how that person’s day/night has been. Risk assessments seen on two of the files checked were detailed and covered a range of issues. There was evidence on both files that the assessments had been reviewed and updated. All files seen contained information on how other healthcare needs are met. A dietician visits when requested, and there were records to show that service users see an optician, dentist and chiropodist as required. It was disappointing that two service users on the ground floor presented as though their personal care needs were not being met. Both people had an unpleasant odour and it looked as though neither had had facial hair dealt with for some time. One person had very black teeth and very sticky eyes. Their clothes were not clean. One person was wearing tight, short stockings which were digging into swollen ankles, and a nametag was visible on one of the stockings. One person’s pink cardigan had had a blue button sewn on as a replacement for a lost pink button, and was wearing nail varnish which was very badly chipped. The manager explained that one of these people chooses not to be assisted with personal care. On each floor there is an office where care plan files are kept. The files were in open boxes on the desk and both offices were unlocked at the time of the inspection, although it was only on the ground floor that there were no staff present for some considerable time. Care plans must be stored securely so that confidentiality is maintained. Medication is stored in a locked room on each floor. The medication trolleys are secured to the wall inside the locked room, and controlled drugs are in a separate locked cupboard. There is a lockable fridge for storing medications that have to be kept cold. Medication Administration Record (MAR) sheets were checked on one floor and had been completed correctly. The controlled drug record was also completed correctly. It was noted that the staff had taken the temperature of the room daily and had recorded that the temperature goes up to 260C. Medications have to be Cherry Hinton Nursing Home DS0000024283.V291772.R01.S.doc Version 5.1 Page 11 stored below 250C to ensure they do not deteriorate. The manager said that air-conditioning would be fitted in the two rooms. A tube of aqueous cream, not named to an individual resident, was in the cupboard in the shower room: all creams should be for the use of one person only and should be stored safely in the person’s own room. Cherry Hinton Nursing Home DS0000024283.V291772.R01.S.doc Version 5.1 Page 12 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): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to make choices in all aspects of their lives. EVIDENCE: A programme of activities was on display in each bedroom and service users spoke about the outings they had been on. Trips had taken place to several local garden centres and the Grafton shopping centre. One service user confirmed that the advertised activities do take place, and said she has plenty to do during the day, including choosing books to read from a number of bookcases around the home. Activity records seen in one person’s file showed that a range of activities takes place. Visitors to the home said they are welcome to visit any time. One service user said the food is very good. She explained that staff take a menu round daily for service users to choose the meals they would like for the next day. Cooked breakfast is available every day for anyone who wants one and service users choose whether they have breakfast in their bedrooms or in the dining rooms. There is always a choice of main course at lunchtime, or omelettes and soup are available, and a choice of dessert. Fish is always
Cherry Hinton Nursing Home DS0000024283.V291772.R01.S.doc Version 5.1 Page 13 served on Fridays, but with lots of variety. This person said the quality of the food is very good. The meal seen on the day of the inspection looked appetizing and nutritious. Special diets are catered for, and liquidised food is served attractively. Cherry Hinton Nursing Home DS0000024283.V291772.R01.S.doc Version 5.1 Page 14 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): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users know that their concerns will be listened to and acted on. Some staff have not received training in the protection of vulnerable adults so the home cannot be sure that service users are fully protected. EVIDENCE: A record of complaints is kept in a file: the last complaint received was in March 2006. A service user said she would be happy to speak to the manager if anything was not right and she felt confident the problem would be sorted, but she had never had to complain. One relative said they would be able to raise concerns, but they had never needed to. The manager and the home’s administrator had recently undertaken a four-day “training the trainers” course in Protection of Vulnerable Adults (POVA) and will be training the rest of the staff team. The manager said that all staff had done POVA training, but not within the last year. This meant that newer staff would not have had this training. The file of the newest member of staff indicated that this person had not received any training in POVA. The manager was aware that there is only a brief mention of abuse on the revised induction form. One staff member spoken to felt confident that she knew about abuse and would have no hesitation in reporting any concerns. Cherry Hinton Nursing Home DS0000024283.V291772.R01.S.doc Version 5.1 Page 15 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, 24, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally the home is clean and well-maintained so that service users have a comfortable, homely place to live in. EVIDENCE: Generally the standard of maintenance and decoration at this home is very good, other than the corridor carpet upstairs which was looking very discoloured and worn. The manager said this carpet was due to be replaced by the end of June 2006. The gardens to the side and rear of the home are attractive and well-kept. Garden furniture is available for people to sit outside, on both paved and grass areas, and shade is provided by the surrounding trees and by parasols. Some service users choose to eat their tea in the garden. It was very pleasing to see that bedrooms had been nicely prepared for the new service users arriving that day and the following day. There were flowers for the ladies, and toiletries for the gentlemen, as well as a welcome pack in each room. It was clear from the occupied bedrooms seen that service users
Cherry Hinton Nursing Home DS0000024283.V291772.R01.S.doc Version 5.1 Page 16 are encouraged to personalise their rooms, bringing in their own furniture and belongings if they want to. Double rooms have curtains to screen each section of the room. All areas of the home seen were clean. However, there was a strong smell of stale urine on entering the ground floor, along the corridor and in several of the ground floor bedrooms. Cherry Hinton Nursing Home DS0000024283.V291772.R01.S.doc Version 5.1 Page 17 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): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good recruitment procedures ensure staff are suitable to work with vulnerable adults, and an adequate number of staff are employed to meet the needs of the service users. A range of training is offered to staff so that they develop the skills they need to do the job properly. EVIDENCE: On the day of the inspection there were enough staff on duty to meet the needs of the service users. Both staff and service users said that there are usually enough staff on duty. Both of the staff files checked contained a record of the detailed induction programme which is undertaken by all new staff. Training records, and discussion with the manager, indicated that staff are offered a wide range of training opportunities, and all mandatory training topics (moving and handling; food hygiene; infection control; first aid; and fire safety awareness) are kept up to date. One staff member said all mandatory topics were covered during induction in July 2005: no further training has been undertaken by this person. The manager has been trained as a trainer and trains the staff herself in some of the topics. Cherry Hinton Nursing Home DS0000024283.V291772.R01.S.doc Version 5.1 Page 18 One of the staff was undertaking a course on dementia at Anglia Ruskin University and on the day of the inspection four staff were on the first day of a two-day course on dementia at Homerton college. Some of the staff working at the home are from overseas so do not have English as their first language. The manager is aware that occasionally there are issues with language mis-interpretation: she must continue to monitor this issue closely and deal with any problems that might arise. One relative said that sometimes there are difficulties communicating with staff, especially over the telephone. One service user felt that the majority of the staff understand enough to know what she needs. The personnel records of two members of staff were inspected. One person had worked at the home for almost a year and one for a few weeks. The files contained all the information required by the regulations, for example two satisfactory written references, a record of a Criminal Record Bureau disclosure check, and a record of a POVA-1st check. Any gaps in employment shown on the application forms had been explored and a record made of the reasons for the gaps, and each person had declared they were medically fit for this work. Cherry Hinton Nursing Home DS0000024283.V291772.R01.S.doc Version 5.1 Page 19 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): 31, 33, 35, 36, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home is good so that service users generally receive a high quality service. Record-keeping has improved so that there is evidence of the care offered. EVIDENCE: The manager is a qualified nurse and has several years’ experience in managing this home. The improvements identified at this inspection indicate that the manager and her staff team have worked hard to improve the quality of the service offered at the home. The home uses several methods to check that the service offered is of a high quality. The manager described a tool that the home’s staff use to carry out a detailed annual audit, and an external organisation has been paid to carry out a detailed inspection of all aspects of care. Service users and relatives are
Cherry Hinton Nursing Home DS0000024283.V291772.R01.S.doc Version 5.1 Page 20 sent satisfaction questionnaires to complete and the results are published on the home’s notice boards. These were not seen at the time of the inspection. The home does not deal with finances for any of the service users. Records were seen which showed that staff receive regular supervision. Records relating to service users have improved (see standard 7). Risk assessments are carried out and staff receive training in matters of health and safety. There were no health and safety issues identified during the inspection which gave the inspectors any cause for concern. Cherry Hinton Nursing Home DS0000024283.V291772.R01.S.doc Version 5.1 Page 21 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X 3 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X N/A 3 X 3 Cherry Hinton Nursing Home DS0000024283.V291772.R01.S.doc Version 5.1 Page 22 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 OP9 Regulation 13(2) Requirement The registered person must make suitable arrangements for the storage of medicines. 1) Medicines must be stored below 250C. 2) Creams must be stored securely. The registered person must ensure that proper provision is made for the care of service users, and that their privacy and dignity are respected at all times. 1) appropriate personal care must be offered. 2) personal information must be stored securely. All staff must receive training in the protection of vulnerable adults. The carpets identified as being discoloured and worn must be repaired or replaced. All parts of the home must be kept free from offensive odours. Timescale for action 30/06/06 2 OP10 12(1)(b) & 12(4)(a) 30/06/06 3 4 5 OP18 OP19 OP26 13(6) 16(2)(c) 16(2)(k) 31/07/06 30/06/06 30/06/06 Cherry Hinton Nursing Home DS0000024283.V291772.R01.S.doc Version 5.1 Page 23 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 OP30 Good Practice Recommendations It is recommended that training in the protection of vulnerable adults should be included in staff’s induction training. Cherry Hinton Nursing Home DS0000024283.V291772.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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