Inspection on 20/06/05 for Cherry Hinton Nursing Home

This inspection was carried out on 20th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cherry Hinton Nursing Home 04/05/07

Cherry Hinton Nursing Home 11/05/06

Cherry Hinton Nursing Home 07/09/05

Cherry Hinton Nursing Home 11/02/05

Cherry Hinton Nursing Home 30/06/04

Similar services:

Claremont House

Chesham House

Oak Ridge

Argyll House

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

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

CARE HOMES FOR OLDER PEOPLE Cherry Hinton Nursing Home 369 Cherry Hinton Road Cambridge Cambridgeshire CB1 4DH Lead Inspector Shirley Christopher Announced 20 June 2005 @ 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cherry Hinton Nursing Home Version 1.10 Page 3 SERVICE INFORMATION Name of service Cherry Hinton Nursing Home Address 369, Cherry Hinton Road, Cambridgeshire CB1 4DH 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) 01223 210071 01223 413572 n/a 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 disabilty or of places dementia- over 65 years of age (20), Old age, not falling within any other category (20) Cherry Hinton Nursing Home Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 11 February 2005 Brief Description of the Service: Cherry Hinton is a large purpose built building, just off the Cherry Hinton Road. It provides accomodation for up to forty service users, requiring nursing care or who have a formal diagnosis of dementia. The home provides accomodation on two floors, the ground floor accomodates service users with dementia. Most of the bedrooms are single and all are ensuite. The first floor is for service users with a nursing need. There is a third floor which is used as a storage area, staff area and is where the kitchen is situated. The building is secure and there is a large landscaped garden to the rear of the property which is well maintained and has a large lawned area and mature trees. There is ample parking. Cherry Hinton Nursing Home Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection was carried out on the 20th June 2005 over seven hours, between 10.00am and 5.00pm with an hour taken for lunch. Two inspectors undertook the inspection and inspected different floors. The majority of time was spent speaking to service users, (10) relatives, (4) and care staff, (5). There was some direct observation of care practices within the home and some service user records were inspected, (6). No other records were inspected as part of this visit. The manager completed a pre inspection questionnaire, which was returned to the CSCI before the inspection took place. This gives details of how the home is meeting the National Minimum Standards. The home also made relative/visitors comment cards available before the inspection. Four were returned. No adverse comments were made. Feedback was given to the manager and the Regional manager after the inspection. It was noted that the majority of the requirements made at the time of the last inspection had been met, but the home were still working on improving the care plans, which was evident on some files inspected. The timescales for meeting this requirement was not until the end of July 2005. What the service does well: The home offers spacious, purpose built accommodation, which was maintained to high standards of maintenance and cleanliness on the day of inspection. Staff were employed in sufficient numbers and the manager stated that there is a low turn over of staff. A designated person is employed to be responsible for providing activities, although all staff are encouraged to do so. The post is for 20 hours a week and she has been given appropriate training. The manager confirmed that the organisation has a generous training budget and care staff are encouraged to attend training courses, up and above the statutory courses. Staff spoken to confirmed that they had attended recent courses. Staff success is celebrated and the home recently had an award ceremony, attended by the Mayor, and relatives in recognition of staff’s Cherry Hinton Nursing Home Version 1.10 Page 6 achievements in successfully completing different training courses. Over 60 of the care staff have already achieved an NVQ qualification. 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cherry Hinton Nursing Home Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Cherry Hinton Nursing Home Version 1.10 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 standard(s) 3,4,5 A pre admission assessment is completed before admission and care plans are implemented following admission. The homes documentation does not always demonstrate the high levels of care provided. EVIDENCE: A number of service user files were inspected and contained pre admission assessments completed by the home and where appropriate assessments from other agencies. The contracts are held separately and were not inspected on this occasion. There is an opportunity for service users, and, or their relatives to look round the home to see if it is suitable before admission. A service user guide is available to relatives and service users, which gives details of the home, and the services available. A copy of the latest inspection report is available at reception. The home are able to meet a range of care needs, for which staff are given specific training and work in cooperation with other agencies, who provide specific support and advice. The pre admission assessments do not always give Cherry Hinton Nursing Home Version 1.10 Page 9 the fullest information about the needs of the service users and a number of care plans inspected did not accurately reflect the high standards of care given as described by service users and relatives. This is discussed more fully in the next section of the report. Cherry Hinton Nursing Home Version 1.10 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8, Care provided at the home is generally good, but the home needs to continue to improve its written documentation and ensure care plans and daily notes reflect the level of care provided. EVIDENCE: A number of service user records were inspected and included Pre admission assessments completed by the home and other agencies, a photograph, basic information on admission, discharge letters/assessments, care plans covering broad aspects of health and social care, social histories and record of daily social activities, risk assessments, accident/incident records, consent forms from relatives, in relation to bedrails and involvement in care plans, record of visits from health care professionals, nutritional and weight records, wound care, manual handling, and continence assessments were also seen. The RCN assessment tool covered essential care components. Daily records are also kept. The standard of record keeping has improved since the last inspection and care plans are being newly implemented. On the files inspected some records were still not being dated or signed. Staff should also record the time they take Cherry Hinton Nursing Home Version 1.10 Page 11 blood for testing blood sugar levels. Risk assessments were completed but gave minimal information, some records could be archived, particularly in relation to wound care, where the skin has healed and there is no further medical intervention required. Poor documentation in some instances did not always reflect the care being given. Weight on admission is not always recorded. Where service users refuse, this should be recorded. Some basic information was not recorded, on some files, such as who their doctor is. Care plans were not always in place for the management of specific conditions. Some care plans give details of what staff should do, but does not tell them how to do it, or how it should be recorded. The RCN assessment should provide more justification to why service users have been given the score they have, which in turn helps to identify the level of nursing input they are likely to require. No evidence was provided that service users are involved in the implementation of their care plans, although evidence was provide of the next of kin’s involvement. The information collected before admission could be in more detail. A further concern was around the terminology occasionally used in the daily notes. Daily entries should be descriptive rather than using behavioural terms such as aggressive or agitated. The rationale for the administration of medication prescribed when necessary for aggressive or agitated states must be explicit. It is not adequate to record agitated, medication administered. Other measures for managing difficult behaviour are detailed in the care plans and the use of medication is always as a last resort. This should be reflected in the daily care notes. The daily notes should make reference to how the care plan has been followed. Feedback from relatives spoken to was mainly complimentary. The standards of care provided were felt to be high and it was stated that there is a family atmosphere at the home. One relative compared the home favourably with a previous care home and felt that her relative’s health had vastly improved since admission to the home. Feedback from service users was sought where possible but due to the nature of dementia it was not possible to get comprehensive information from some service users. Observations were made of the care practices in the home, which were generally favourable. Some service users stated that the home was not too bad, the food was good and there is always a choice. Care staff were said to be polite and always knock before entering bedrooms and address service users how they want to be addressed. They were aware of the complaints procedure, but did not have any specific concerns. They commented on the shortness of staff recently, which meant they had to wait for staff assistance for some things. Cherry Hinton Nursing Home Version 1.10 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 standard(s) 12,13,15 There is potential to expand the range of meaningful social activity available to service users, through improved documentation and service user and relative involvement. EVIDENCE: On the day of inspection there was an afternoon of music, which was well attended, with both staff and service users joining in the singing. Different social events were being advertised around the home and a marquee was in the garden, following birthday celebrations. The home employs a member of staff who has split duties as a care worker and designated time as an activities coordinator, for which she has received training. Planned activities take place throughout the week. It was noted throughout the inspection that service users particularly on the dementia care unit were attended to promptly. There was soft music playing throughout the home and the television in the main lounge was turned off. Service users were sat for some time in the lounge, some of who were asleep. They all had personal possessions around them and there were some games in both the lounge and conservatory. On the first floor the home was clean and tidy. Both the radio and the television were on. Cherry Hinton Nursing Home Version 1.10 Page 13 A number of service users stated that there was not much to do and one relative felt that physical health care needs are met, but care staff do not always spend as much time thinking about the social care needs of service users. This is being addressed through the development of social life histories and social care plans. A record of activities is recorded in each service user’s file. Staff tick which activity service users have been involved in on a daily basis from a list of about twenty activities. There is no active evaluation of the activity, such as did the service user enjoy it, participate for very long and is it worth repeating. Social life histories are still in their infancy and should be covered in more detail. One service user was described as liking music and television, but did not state what her favourite programmes were or what music she liked to listen to The manager stated that there is additional staff available to assist at mealtimes. The arrangements at lunchtime have been changed recently to ensure that appropriate supervision is provided. Service users requiring assistance with their food are served their meals first. Service users requiring minimal supervision have their meals in the main dining room. Relatives and service users spoken to were complimentary about the food. The lunchtime meal was served at approximately 12.30 and service users were supervised appropriately. Copies of the homes menus were sent to the CSCI prior to the inspection and show a varied, balance diet is offered to service users. The home had special measures in place to compensate for the hot weather. Service users were being given additional fluids and choc -ices. Cherry Hinton Nursing Home Version 1.10 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 standard(s) 16,18 The home has the appropriate policies and procedures in place and staff receive training in the protection of vulnerable adults. EVIDENCE: The manager confirmed that the complaints procedure has been updated and all complaints are recorded and dealt with as detailed in the homes complaints procedure. The home has policies and procedures in place for the protection of vulnerable adults, although these were not requested. The manager confirmed that all staff have received external training on the protection of vulnerable adults. Cherry Hinton Nursing Home Version 1.10 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 standard(s) 19,20,21,22,23,24,25, The standard of the environment of the home is good providing service users with a comfortable, clean and well-maintained place to live. EVIDENCE: A tour of the home was conducted and it was noted that all areas of the home were maintained to an extremely high standard and no immediate hazards were identified. The bedrooms are individually furnished with room for a number of personal items. Most bedrooms are single with two double bedrooms on each floor. All have en-suite facilities. All areas of the home were bright and airy and special measures had been put in place to cope with the heat. Cherry Hinton Nursing Home Version 1.10 Page 16 Service users were either in the main lounge, their bedrooms or the conservatory. In the afternoon the majority of the service users were downstairs in the main dining room for some musical entertainment. The gardens were beautifully maintained and the manager stated that relatives had been encouraged to do some planting. It was noted that no one was outside enjoying the sunshine. Appropriate equipment is provided as appropriate and bathing and toileting facilities were adequate. Cherry Hinton Nursing Home Version 1.10 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,30 Staffing levels are good and staff receive appropriate training to enable them to meet the health care and social care needs of service users. EVIDENCE: Staff are employed in sufficient numbers and are given appropriate training and support. A number of the trained staff are from other countries and have to complete an adaptation programme before their qualification is recognised. The manager stated that staff’s abilities vary according to where they received their initial training. In some other countries trained staff do not complete personal care tasks. Staff are supervised until they are deemed competent. One member of trained staff has been asked to undertake a NVQ qualification. Five staff were spoken to. The training opportunities at the home were described as very good. A number of staff have completed a twenty- week course in dementia care at Cambridge Regional College and the head of care an ENB course in dementia in elderly care. Statutory training had been covered: fire training, manual handling, first aid, and food hygiene. Other courses included, palliative care, catheter care, managing challenging behaviour, medication, wound care, infection control and protection for vulnerable adults. 60 of care staff already hold an NVQ qualification and additional staff are studying for NVQ. Some staff are also doing the adaptation course and one member of staff is doing the NVQ assessors award. The head of care on the ground floor is the link nurse for diabetes. Cherry Hinton Nursing Home Version 1.10 Page 18 The manager was said to be accessible and supportive of staff. Staff would have no hesitation of raising concerns with her. Staff though it was a good company to work for, available training and equipment were considered it main strengths. Staffing rotas were not inspected on this occasion, but copies of rotas were sent to the CSCI, as part of the pre inspection questionnaire. The manager confirmed that there was a staffing vacancy of 35 hours per week, but she was interviewing later in the week. On the day of inspection there were eight staff on duty, excluding the manager. There is a head of care on each unit. There is also a team of domestics, an administrator, a full time chef and kitchen assistant. All staff employed assist care staff at particular times of the day when they are busy such as mealtimes. They have received appropriate training. Staff confirmed that they attended regular staff meetings, had received induction and had regular supervision, although their understanding of supervision was based on clinical practices. Further evidence of this was not requested and no staff files were inspected. Staff showed a good understanding of service user’s needs and care staff are being trained in care planning, an area previously only undertaken by trained staff. Social care needs are being recorded as part of the care plan. Staff interviewed were aware of the role of the CSCI and had seen copies of previous inspection reports. Staff were reassured that the purpose of these inspections was not to unduly criticize, but to identify areas where the home performs well and areas where the home fall short of the minimum standards. Cherry Hinton Nursing Home Version 1.10 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36,37,38 The home has all the required policies and procedures in place. They have systems in place to ensure the maintenance and testing of equipment. EVIDENCE: The manager completed a pre inspection questionnaire, which provided evidence of staff training, the maintenance and testing of equipment, sample menus, staffing rotas, list of staff employed and service users living at the home. No staff files were inspected on this occasion, but staff interviewed confirmed that they received regular training, supervision and support. Cherry Hinton Nursing Home Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 4 4 3 3 3 3 3 x STAFFING Standard No Score 27 3 28 4 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x 3 3 3 Cherry Hinton Nursing Home Version 1.10 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 4 Regulation 14 Requirement Pre admission assessments must be completed as fully as possible to enable the home to decide if the home is appropriate to meet the identifed needs of the service users at the point of admission and these needs must be addresed fully in care plans Care plans must be kept under review and provide up to date information on service users, strengths and needs. Guidelines should be in place to assist staff in working consistently with service users and they should know how to manage a particular behaviour Care staff should have input into the plan of care and work in accordance with them. Records must be dated and signed. (This is a previous requirement the timescale set was the 30 July 2005.) The home must keep all the records in the home required by Schedule 3 of the Care Home Regulations. All records must be up to date. Care-plans must address more than the physical needs of the Version 1.10 Timescale for action 31 August 2005 2. 7 14/15 30 July 2005 3. 7 17 31 August 2005 4. 12 16 30 July 2005 Page 22 Cherry Hinton Nursing Home service user and give descriptive social histories and routines of daily living. (This was a previous requirement the timescale set was the 30 July 2005.) 5. 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 7 Good Practice Recommendations The language used in the daily record sheets should be clear and describe the needs of the service users, how they are to be met, recorded and evaluated. They should be specific and daily notes should refer to how the care plan has been followed. Social activities should be reviewed in terms of their appropriateness, Life stories should be in greater detail where the information is made available and include specific rather than general information about the service users likes, dislikes, hobbies and interests. 2. 12 Cherry Hinton Nursing Home Version 1.10 Page 23 Commission for Social Care Inspection CPC1, Capital Park Fulbourn Cambridge CB1 5XE 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. Extracts may not be used or reproduced without the express permission of CSCI Cherry Hinton Nursing Home Version 1.10 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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