Inspection on 04/06/07 for Collyhurst

This inspection was carried out on 4th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Collyhurst 05/12/08

Collyhurst 04/09/06

Collyhurst 16/01/06

Collyhurst 14/09/05

Collyhurst 14/10/04

Collyhurst 08/04/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Collyhurst 31-33 Nuneaton Road Collycroft Bedworth Warwickshire CV12 8AN Lead Inspector Key Unannounced Inspection 10.30 4th June 2007 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 Collyhurst DS0000004206.V340036.R01.S.doc Version 5.2 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. Collyhurst DS0000004206.V340036.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Collyhurst Address 31-33 Nuneaton Road Collycroft Bedworth Warwickshire CV12 8AN 02476 319092 F/P 02476 319092 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) Mr K Taylor Mrs Elizabeth Taylor Mr Charles George Taylor Care Home 22 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (1), Old age, not falling within any of places other category (21) Collyhurst DS0000004206.V340036.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Any admission of a person under the age of 65 shall be agreed with the Commission for Social Care Inspection in advance. The registered person may provide personal care (excluding nursing) and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories:old age, not falling within any other category, OP, 21; mental disorder excluding learning disability or dementia, MD, 1. The maximum number for service users to be accommodated is 22. 3. Date of last inspection 4th September 2006 Brief Description of the Service: Collyhurst Home is a family owned and run care home, which is situated in the Collycroft area of Bedworth. The home is registered to provide care for the older person and one younger adult with specialist needs. Collyhurst is located on the main road, which links to the two towns of Nuneaton and Bedworth and is very convenient for local services, hairdressers and shops, and a community centre, which is within close walking distance. There is currently only on road parking but there is a public car park by the community centre. Accommodation is provided both in the main building and a small bungalow, which is situated to the rear of the property. Service user accommodation is comprised of 18 single rooms and 2 shared rooms. The bedrooms in the main house are accessible via a passenger lift or stairs. The bungalow has it’s own small kitchen and lounge facility and accommodates up to four service users. There are pleasant garden areas at the rear of the home, which are accessible to all current service users. At the time of the inspection visit the fees charged are in the range £300.00 £375.00 per week. The fees do not include newspapers, toiletries, chiropody or hairdressing. Collyhurst DS0000004206.V340036.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the inspection the home was sent questionnaires to distribute to residents and visitors to seek their independent views about the home and the services provided. Completed questionnaires were received from one visitor and one resident and responses are included where appropriate in this report. In April the registered manager of the home returned a completed preinspection questionnaire containing further information about the home as part of the inspection process. Some of the information contained within this document has been used in assessing actions taken by the home to meet the care standards and included in this report. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (where possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. Other records examined during this inspection included, care records, staff recruitment records, training records, social activity records, staff duty rotas, health and safety records and medication records. The inspection process also included a review of policies and procedures, discussions with the manager, staff, residents and visitors. This inspection took place from 10.30am to 07.00pm. What the service does well: Pre-admission assessments were well detailed and covered all required areas of assessment ensuring that the home was able to meet the needs of prospective residents before a decision is made for the person to move in. One resident’s assessment demonstrated that it had been carried out over two four hour visits to the home to ensure that the complex needs of this resident could be met and giving the resident more time to to make an informed choice about living at the home. All areas of need were included in care plans. These were in sufficient detail to enable staff to provide the care required to meet the needs of the residents. A care plan described the care required for a resident who was recently bereaved demonstrating that emotional needs were being addressed. All care plans viewed had been reviewed monthly and revised as necessary to ensure that all needs are met. Collyhurst DS0000004206.V340036.R01.S.doc Version 5.2 Page 6 Records evidenced that residents have access to a GP, District Nurses, an optician, a dentist, a chiropodist and the mental health team to meet their health care needs. A comment made in a survey completed by a relative of a resident was – “Any medical needs are seen to very promptly.” Risk assessments were available in the care files for pressure sores. Pressure relieving equipment such as cushions and mattresses were in use. The staff responsible for medication had undertaken appropriate medication training. The medication procedures and practices at the home safeguard residents from risk. The interaction between staff and residents was in the main respectful. Residents spoken with said that they were treated respectfully and spoke well of the staff. The activities described in the diary, activity records and preinspection questionnaire included arts and crafts, Pat-a-Pet, sing-alongs, board games, jigsaws, bingo and visiting musicians and pantomimes. Samples of the crafts carried out were on display in the home. The minutes of residents’ meetings discussed the hanging baskets that were to be completed by residents from seeds planted by them. Outings are said to include local pubs and clubs, the town centre, parks, the library and the civic hall. Residents spoken with said that they were sufficiently occupied during the day. Church services are held regularly and residents with less mainstream religions are supported to continue their worship. Two visitors were spoken with during the visit and both said that they were made to feel welcome when visiting their relative at the home. Visiting is at any reasonable time and there are no restrictions other than any made by the resident. Residents spoken with said that they were able to make choices in their daily lives; for instance in the times they went to bed and got up, the activities they joined in with and a choice of meals each day. Those residents who were asked said that the times they had their bath had to fit in with the care staff routine. Care plans and discussion with residents and the manager showed that they have a choice of whether they have a key to lock their bedroom if the wish. Residents spoken with were not aware of the complaints procedure but said that they knew who to complain to if they had any concerns. A visitor spoken with during the visit said, “I have no worries about discussing concerns with the manager.” There have been no complaints since the last key inspection. Collyhurst DS0000004206.V340036.R01.S.doc Version 5.2 Page 7 An adult protection policy, revised in 2006, was in place. Staff have attended Vulnerable Adult training in order that they have the knowledge and skills to identify abuse and to safeguard residents. There have been no allegations of abuse. The parts of the home seen were comfortable, and homely and were generally clean and well maintained. Apart from the corridor leading off the reception hall the home was free of offensive odours. Residents spoken with made complimentary comments about the staff. In a survey completed by a relative the questions, “Does the care home give the support or care to your relative that you expect or agreed?” and “Do the care staff have the right skills and experience to look after people properly?” answered “Always” to both questions. The relative also recorded the comment, “I know my mother is in good hands.” Over three quarters of the care staff have achieved National Vocational Qualification (NVQ) Level 2 or 3 in Care thereby exceeding minimum of 50 of staff to have this qualification. Other staff were working towards achieving this. Staff files looked at supported that there was good recruitment practice to ensure that only appropriate people were employed at the home and thereby safeguarding residents. The registered manager has the Registered Managers Award and has had several years experience in managing the home. The care manager who has achieved NVQ Level 3 supports him. Staff spoken with during the day said that they felt supported by the managers and could talk to them about any concerns. COSHH (Control of Substances Hazardous to Health) items were stored safely; wheelchairs footrests were all in place; all maintenance and servicing documentation was up to date and all fire prevention checks had been carried out appropriately, including the annual service of fire extinguishers. Fire training for staff was due to be undertaken in the near future. What has improved since the last inspection? Pre admission assessments had been carried out in detail in all the care files looked at, which enables a care plan to be devised and the residents’ needs to be met. All care plans viewed were written in sufficient detail to enable staff to provide the care required to meet the needs of the residents. Risk assessments were available in the care files for pressure sores, moving and handling and nutrition as well as for individual personal risks, such as smoking. Collyhurst DS0000004206.V340036.R01.S.doc Version 5.2 Page 8 There are regular activities organised that reflect the wishes of the people living at the home. The duty rota includes the full name, and capacity in which they work, of all people working at the home, including the registered manager. A formal quality assurance system been introduced to monitor and to make sure that all services and procedures in the home operate in the service users’ best interests but this had not yet been fully implemented. Surveys are issued to residents on occasions for feedback on the services offered at the home but these have not been distributed yet this year. Residents meetings are held regularly in which residents have the opportunity to discuss their views of the home and the services offered. What they could do better: Those care plans looked at did not provide evidence that the resident had been involved in devising the care plans or that they had any choices in decisions about how their care was delivered. One care plan looked at recorded that the resident could not be weighed as they could not weight bear. If a resident is unable to use the scales in the home care plans must describe an alternative method of monitoring whether someone has lost or gained weight, in order to determine if the resident’s nutritional needs are being met. On one occasion during the visit a member of staff was heard to be talking to a resident in a manner that was not age appropriate. The registered manager advised that they did not approve of this behaviour and that it would be addressed with the member of staff. Lunch provided on the day of the visit was barely lukewarm and the method of reheating was not safe. Food must be maintained at a temperature of 63°C heated until it is served and if it must be reheated must be piping hot all the way through. Gravy was also put on the meal prior to being brought to the table and there was no sauce available for the fish. To encourage independence and to enable choice there should be some self-service of the meal, at minimum the gravy/sauces/custard being on the table for residents who are able to do so to help themselves. A resident recently diagnosed as having diabetes said “I am fed up” of the limited choice and from feeling different. The registered manager needs to address this in order to ensure that the diabetic needs and the resident’s wishes are met and to avoid the feeling of difference. Residents were using plastic beakers, which are not age appropriate. If these have to be used for some people, as an alternative to glass, the reasons must be identified in the individual’s care plan or risk assessment. Collyhurst DS0000004206.V340036.R01.S.doc Version 5.2 Page 9 The décor of some of the bedrooms needed improving but the registered manager advised that this would come about with the planned building work. On the rotas provided and on the day of the visit there were no catering or cleaning staff before 10am or after 2pm, no cleaner was shown to be working on a Sunday on all three rotas provided and no cook on two of the three rotas. The care and senior staff must therefore carry out domestic and catering tasks during these hours, which is time taken away from the residents or management tasks. Although a Quality Assurance programme has been purchased it has not yet been fully implemented therefore the home does not demonstrate that it is monitoring the service to ensure that it is in the beast interests of the residents. The kitchen doors were found to be propped open creating a high risk to residents and staff in the event of a fire in this high-risk area. If doors need to be kept open they need to be fitted with an appropriate device linked to the fire alarm system to ensure that they close in the event of a fire. 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. The summary of this inspection report can be made available in other formats on request. Collyhurst DS0000004206.V340036.R01.S.doc Version 5.2 Page 10 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 Collyhurst DS0000004206.V340036.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. The home has sufficient information prior to a resident moving into the home to be able to assess if they can meet the person’s needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are plans for major building works in the home and the registered manager advised that the Statement of Purpose and Service User Guide will be revised when this work has been completed. Pre-admission assessments of recently admitted residents were looked at. These were in well detailed and covered all required areas of assessment ensuring that the home was able to meet the needs of prospective residents before a decision is made for the person to move in. The pre-admission assessment of resident with complex needs showed that it had been carried out during two visits of four hours to the home by the prospective resident Collyhurst DS0000004206.V340036.R01.S.doc Version 5.2 Page 12 giving the assessors more time to ensure this person’s needs could be met at the home and gave the person an opportunity to make a more informed choice about living at the home. Residents referred to the home by social or health services had a summary of a care management assessment and care plan. All care files looked at had a care plan that had been written from the assessments held. Collyhurst DS0000004206.V340036.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. Care plans are in place to provide staff with the information they require to meet individual needs but these are not devised with the residents and/or their representatives. Medication practice safeguard residents and care is generally given in a respectful manner. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three residents were chosen to be care tracked and their care files were examined. One was a recently admitted resident in order to assess any progress in the pre admission assessment. All areas of need were included in the care plans. These were in sufficient detail to enable staff to provide the care required to meet the needs of the residents. One care plan described the care required for a resident who was recently bereaved demonstrating that emotional needs were being addressed. A further care plan of a person with a high risk of developing pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area) described the care needed to prevent the sores occurring. All care plans included information about oral health including dental check appointments, and information about foot care including chiropody treatment. Collyhurst DS0000004206.V340036.R01.S.doc Version 5.2 Page 14 Those care plans looked at did not provide evidence that the resident had been involved in devising the care plans or that they had any choices in decisions about how their care was delivered. All care plans viewed had been reviewed monthly and revised as necessary to ensure that all needs are met. There was evidence in all the care files examined and in the pre-inspection questionnaire returned by the registered manager, that residents have access to a GP, District Nurses, an optician, a dentist, a chiropodist and the mental health team to meet their health care needs. This was further evidenced in conversation with residents and staff and observed when a GP was called for a resident during the inspection visit. A comment made in a survey completed by a relative of a resident was – “Any medical needs are seen to very promptly.” Risk assessments were available in the care files for pressure sores, moving and handling and nutrition as well as for individual personal risks, such as smoking. One risk assessment for moving and handling omitted to refer to the size of sling used but as the resident is currently the only person with a hoist sling this does not currently create a risk to that person. Pressure relieving equipment such as cushions and mattresses were in use, including for one of the residents case tracked and who had pressure-relieving aids to minimise pressure to the heels. One care plan stated that a resident could not be weighed because they were unable to stand. There was no alternative method of monitoring if the resident had lost or gained weight. Without this information it cannot be determined if the resident’s nutritional needs are being met. Residents looked well cared for and well groomed, apart from one resident whose nails were fairly long and dirty. When pointed out to the manager the resident was offered, and accepted, nail care immediately. The nails of other residents were seen to be clean and manicured. Medication is kept in a trolley in a designated storeroom and as advised by the manager and observed on the day of the visit is administered to residents, one at a time. The room was dusty and the carpet sticky and dirty creating a potential for cross infection. The manager said that this would be attended to promptly including replacing the floor covering to one that can be easily cleaned. The Pharmacist supplies tablets in multi dose cassettes. All tablets to be taken a specific times of day are put in the specific sections of the cassette for those times, which makes identifying individual tablets more difficult than whe each tablet is bubble-packed separately. However the cassettes have the description of the medication on the reverse and the manager advised that the pharmacist Collyhurst DS0000004206.V340036.R01.S.doc Version 5.2 Page 15 updated these each week. Medication for the three residents case tracked were audited. There were no unexplained gaps on the Medication Administration Record Sheets, supporting that medication had been administered correctly. The medication received into the home is recorded on the Medication Administration Record Sheets but any medication not in the cassettes that is carried over from the previous month is recorded in a designated book. Recording received medication on the Medication Administration Record Sheets makes auditing more straightforward. The staff responsible for medication had undertaken appropriate medication training. They had provided a sample of their signature at the front of the Medication Administration Record Sheets file so that it is easier to identify who has administered the medication. Photocopies of prescriptions are kept as a check that what has been supplied was ordered by the GP. The interaction between staff and residents was in the main respectful although on one occasion a member of staff was heard to be talking to a resident in a manner that was not age appropriate. This was pointed out to the manager who advised that the management did not approve of this behaviour and that it would be addressed with the member of staff. Residents who were asked said that they were treated respectfully and spoke well of the staff. A resident assisted to transfer from armchair to wheelchair with a hoist was managed with respect, and dignity was maintained. Collyhurst DS0000004206.V340036.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. Residents are offered sufficient and appropriate activity for them to be stimulated and occupied. Visitors are made to feel welcome and residents are able to make choices in their daily lives. There are shortfalls in the food provided that could create risks to people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an activity diary that is devised each week. The care manager, who is responsible for organising this said that this was planned in line with residents wishes and was also flexible as to what they wanted to do each day. The activities described in the diary, activity records and pre-inspection questionnaire included arts and crafts, Pat-a-Pet, sing-alongs, board games, jigsaws, bingo and visiting musicians and pantomimes. Samples of the crafts carried out were on display in the home. The minutes of residents’ meetings discussed the hanging baskets that were to be completed by residents from seeds sown by them. Outings are said to include local pubs and clubs, the town centre, parks, the library and the civic hall. Residents spoken with said that they were sufficiently occupied during the day. Although there was no planned Collyhurst DS0000004206.V340036.R01.S.doc Version 5.2 Page 17 activity taking place at the time of the visit the lounge/ dining room was lively and residents seemed contented. One resident returned a completed survey to us and answered “Usually” to the question “Are there activities arranged by the home that you can take part in?” The manager advised that one resident had recently arranged to go to Blackpool with his family and was involved with the day-to-day arrangements. Church services are held regularly. The church visits one resident, who is of a diverse Christian denomination, weekly for Communion. The manager advised that Christmas and Easter are at the same time of year as is celebrated by main stream Christians for three years out of four but on the fourth year when these occasions are celebrated at a different time the home ensures that they support the resident to celebrate by, for example, appropriate decorations in the bedroom. Two visitors were spoken with during the visit and both said that they were made to feel welcome when visiting their relative at the home. Visiting is at any reasonable time and there are no restrictions other than any made by the resident. Residents can be visited in the privacy of their own bedroom or in any of the communal areas. One resident has their relative visit for lunch three times a week. Residents spoken with said that they were able to make choices in their daily lives; for instance in the times they went to bed and got up, the activities they joined in with and a choice of meals each day. Care plans and discussion with residents and the manager showed that they have a choice of whether they have a key to lock their bedroom if the wish. However those residents who were asked said that the times they had their bath had to fit in with the care staff routine. The dining areas were integrated in with the sitting areas and were reasonably attractive, clean, uncreased tablecloths were on the tables, and serviettes were provided. Lunch was taken with the residents and there was a choice of breaded turkey fillets or fish fingers. Although both of these choices were ready made meals they were served with fresh and frozen vegetables. The meals were brought up from the lower ground floor kitchen in a heated trolley and already plated. Plating meals in this way is considered institutional practice, and limits the residents’ choice as to what is on their plates. The food was barely lukewarm when served to residents. Cooked food must be maintained at 63°C in the heated trolley whilst waiting to be served to prevent the risk of food poisoning and to ensure that residents enjoy their meals. Some residents asked for them to warmed up and they were brought back to them some minutes later. Staff said later that the plates are usually put back into the heating cupboard to warm up. On this occasion temperatures did not seem to be taken to ensure that they had been heated thoroughly and sufficiently Collyhurst DS0000004206.V340036.R01.S.doc Version 5.2 Page 18 enough to avoid the risk of food poisoning as residents said that the reheated food was still only lukewarm. If food has to be reheated it must be piping hot all the way through. Staff said later that the home does not have a microwave to assist this. The manager said that the trolley had not been heated fully on this occasion before being brought up to the dining room and that it was unusual for food not to be hot enough. The gravy was already poured onto the turkey when the plated meals were served. There was no sauce provided for the fish fingers and some residents were asked if they wanted gravy on these. Whilst not all residents would be able to serve their own meals those that can should be given the opportunity to do what they can, and at a minimum be given the opportunity to put gravy/ sauces/custard on the meal themselves. Several residents spoken with said that they had a variety of sandwiches for tea every night and that this got boring. As there are no catering staff on duty after 2pm this may be for convenience and offering a more substantial and varied meal should be considered. A resident recently diagnosed as having diabetes was being offered inappropriate choice of food at teatime and complained to us “I am fed up” of the limited choice as well as “feeling different”. A specific menu for diabetes but related to the main menu needs to be devised in conjunction with the resident to ensure that the diabetic needs and the resident’s wishes are met and to avoid the feeling of difference. Residents were using plastic beakers, which are not age appropriate. If these have to be used for some people, as an alternative to glass, the reasons must be identified in the individual’s care plan or risk assessment. The kitchen was visited and was clean and tidy with ample good quality cold storage. The temperature records for fridges, freezers and cooked food were satisfactory but the temperature of food at serving was not recorded. Collyhurst DS0000004206.V340036.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. Resident and visitors wer aware of how to raise their concerns and were confident they would be listened to. Staff have the knowledge and skills to safeguard residents from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The pre-inspection questionnaire returned to us by the manager said that the complaints procedure had been revised in 2006 but was not looked at during this visit. Residents spoken with were not aware of the complaints procedure but said that they knew who to complain to if they had any concerns. A visitor spoken with during the visit said, “I have no worries about discussing concerns with the manager.” There have been no complaints since the last key inspection. An adult protection policy, also revised in 2006, is in place. Staff have attended Vulnerable Adult training in order that they have the knowledge and skills to identify abuse and to safeguard residents. There have been no allegations of abuse. Staff have signed a document to say that they have read the Adult Protection Policy and the Whistle blowing policy and those staff spoken with understood these policies. Collyhurst DS0000004206.V340036.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is adequate. The home offers generally clean, safe, and homely accommodation with some shortfalls in the physical environment that detracts from its comfort. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is located on the main Nuneaton/Bedworth road with no parking space other than on this road. There is however a public car park within a short walking distance by the local community centre and there is major building work planned that will include a car park. The home has a small, pleasant reception area which leads to a bedroom corridor and the office and then opens out into the communal area. This is a large area sectioned off with pillars. The manager advised that furniture is often rearranged but at the time of the visit the lounge areas were separated by groups of dining spaces. There were ample high occasional tables provided in front of the armchairs, for residents to use. Armchairs were attractive and in Collyhurst DS0000004206.V340036.R01.S.doc Version 5.2 Page 21 good condition and domestic in nature but the dining chairs were metal framed and institutional in appearance. The floor covering of the communal area was clean and in good condition but heavily patterned which can be confusing for people with dementia. The area was pleasantly decorated and lighting that incorporated ceiling fans and was attractive and domestic in appearance. A relative commented in one of our surveys, “ The atmosphere is natural, friendly and relaxed.” There is a bungalow in the grounds that is occupied by residents but this was not fully viewed at the time of the visit as staff training was taking place there. At the near end of the communal area there was a kitchenette for making drinks. The worktops on the units were worn with laminate strips peeling off the edges and created a risk of cross infection. The manager advised that these would be promptly replaced even though the kitchenette is to be removed during the future building work. One of the over bed/chair tables used by a resident in the lounge was also worn and chipped and thus was a source of cross infection. Some bedrooms were viewed including those of the residents that were case tracked. These varied in size and design and in the standard of décor and all had been personalised to the individual and contained items of personal property. The décor of some of the bedrooms needed improving but the registered manager advised that this will come about with the planned building work. The parts of the home seen and that are used by residents were comfortable, homely and were generally clean and well maintained. Apart from the corridor leading off the reception hall the home was free of offensive odours. The laundry area was located on the lower ground floor adjacent to the kitchen and was quite a small room but there are plans for improving this in the future building works. The washing machine had the appropriate programmes for dealing with soiled linen and systems were in place for reducing cross infection. All but one communal toilet had disposable towels and a soap dispenser for hand washing which assist in the prevention of cross infection. The registered manager said that these would be provided in the remaining toilet. Discussion with the managers showed that clinical waste was disposed of appropriately. Collyhurst DS0000004206.V340036.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. The majority of the care staff are suitably qualified and are appropriately recruited but there are sometimes shortfalls in the number and category of staff available in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff were undertaking First Aid training in the bungalow at the time of the inspection visit. To enable as many staff as possible to attend the training the registered manager said that he was assisting the two care staff on duty. The registered manager pointed out that should more staff be needed for any reason they could be called from the training session. However the majority of the shifts on rotas provided by the home were covered by only two care staff and a senior member of staff or on occasions only one care assistant with a senior member of staff although in some instances there were three or four care staff with one or two managers. There were two night care staff working from 9.30pm to 7am each night. There was no indication during observations made that there were insufficient staff available although some staff came from the training to assist at lunchtime, including the care manager who administered medication. Staff spoken to after the day’s training spoke positively about the first aid course. Collyhurst DS0000004206.V340036.R01.S.doc Version 5.2 Page 23 The home also employs a cook, a cleaner and a cook/cleaner, all of whom work four hours a day. There are no catering or cleaning staff before 10am or after 2pm and no cleaner was shown to be working on a Sunday on all three rotas provided or a cook on two of the three rotas. The care and senior staff must therefore carry out domestic and catering tasks during these hours, which is time taken away from the residents or management tasks. Care staff were seen to be vacuuming the dining area carpets after meals. Carers should not be doing catering or cleaning tasks on a regular basis, as this takes them away from providing care to the residents and reduces the care staffing ratios to below the required standard. The rotas seen included the hours worked by the registered manager and showed the capacity in which staff worked as was required after the last inspection, but did not show whether the hours were a.m. or p.m. which could be confusing for inspection purposes. Residents spoken with made complimentary comments about the staff. In a survey completed by a relative the questions, “Does the care home give the support or care to your relative that you expect or agreed?” and “Do the care staff have the right skills and experience to look after people properly?” answered “Always” to both questions. The relative also recorded the comment, “I know my mother is in good hands.” A service user survey completed on behalf of a resident answered “Always” to the questions, “ Do you receive the care and support you need?” and “Are staff available when you need them?” Over three quarters of the care staff have achieved National Vocational Qualification (NVQ) Level 2 or 3 in Care thereby exceeding the requirement for a minimum of 50 of staff to have this qualification. Other staff were working towards achieving this. Staff have also undertaken Moving and Handling training and Fire training since the last inspection. There are plans for a three-day course on Dementia to be undertaken by staff in the near future, giving them the skills and knowledge to be able to meet the relevant needs of residents. Three staff files, chosen at random, were looked at and all contained the required information, including Criminal Records Bureau disclosures, two written references and evidence of training and development. This supported that there was good recruitment practice to ensure that only appropriate people were employed at the home and thereby safeguarding residents from unsuitable staff selection. Collyhurst DS0000004206.V340036.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is adequate. A suitably qualified and experienced person who is supportive of a safe environment manages the home. However systems are in not in place to monitor the service and to demonstrate that action is taken on the outcome. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Collyhurst is a family business with the registered manager and care manager are husband and wife and the parents of the registered manager are the registered providers. The registered manager has the Registered Managers Award and has had several years experience in managing the home. He is supported by the care manager who has achieved NVQ Level 3. Staff spoken with during the day said Collyhurst DS0000004206.V340036.R01.S.doc Version 5.2 Page 25 that they felt supported by the managers and could talk to them about any concerns. A formal quality assurance system has been introduced to monitor and to make sure that all services and procedures in the home operate in the service users’ best interests but this had not yet been fully implemented. Surveys are issued to residents on occasions for feedback on the services offered at the home but these have not been distributed yet this year. Residents meetings are held regularly in which residents have the opportunity to discuss their views of the home and the services offered. Transactions are kept for the small amounts of money held on behalf of residents. These and the cash balances were checked and were in good order. The registered manager advised that families or advocacy services take responsibility for residents’ finances if they are unable or do not wish to do so themselves. During the tour of the home the kitchen doors were found to be propped open creating a high risk to residents and staff in the event of a fire in this high-risk area. If doors need to be kept open they need to be fitted with an appropriate device linked to the fire alarm system to ensure that they close in the event of a fire. However no other doors were propped or wedged open throughout the day. In addition COSHH (Control of Substances Hazardous to Health) items were stored safely; wheelchairs footrests were all in place; all maintenance and servicing documentation was up to date and all fire prevention checks had been carried out appropriately, including the annual service of fire extinguishers. Fire training for staff was due to be undertaken in the near future. Collyhurst DS0000004206.V340036.R01.S.doc Version 5.2 Page 26 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 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Collyhurst DS0000004206.V340036.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15(1) Requirement Residents and/or their representatives must be involved in the care planning process where this is possible. This will ensure that residents are enabled to make decisions about the care they receive. Staff must speak to residents in an age appropriate manner. This will ensure that their dignity is maintained. Cooked food must be stored and served at appropriate temperatures. This will prevent the risk of food poisoning and assist residents to enjoy their food. A specific menu for diabetes but related to the main menu must be devised in conjunction with the resident. This will ensure that the diabetic needs and the resident’s wishes are met and avoid the feeling of difference. A Quality Assurance Programme must be implemented that monitors and audits the services DS0000004206.V340036.R01.S.doc Timescale for action 30/07/07 2. OP10 12 07/07/07 3. OP15 13(4) 07/07/07 4. OP15 13(4) 15/07/07 5. OP33 24 15/08/07 Collyhurst Version 5.2 Page 28 provided at the home. This will ensure that the home is run in the best interests of the residents. The previous timescale of 27/02/07 was not met. 6. OP38 23 If fire doors need to be kept 07/07/07 open appropriate and approved devices must be provided. This will ensure the safety of people living and working in the home in the event of a fire. 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 OP8 Good Practice Recommendations When a resident is unable to use standing weight scales alternative methods of monitoring weight loss or gain should be identified in order that their nutritional needs are maintained. Drinking vessels should be age related, unless a care plan or risk assessment suggests otherwise, so that the dignity of the residents is maintained The decor of bedrooms should be audited and where necessary improved sufficiently to offer the occupants a pleasant environment. The number of ancillary staff hours used in the home should be reviewed to ensure that this is not having an impact on the time care staff can spend with residents or on the cleanliness and hygiene of the home. 2. 3. 4. OP15 OP19 OP27 Collyhurst DS0000004206.V340036.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Collyhurst DS0000004206.V340036.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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