Inspection on 11/09/08 for Comberton Nursing Home

This inspection was carried out on 11th September 2008.

CSCI found this care home to be providing an Good service.

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

Comberton Nursing Home 22/03/10

Comberton Nursing Home 03/11/09

Comberton Nursing Home 15/05/06

Comberton Nursing Home 06/02/06

Comberton Nursing Home 09/08/05

Comberton Nursing Home 24/01/05

Comberton Nursing Home 06/09/04

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 13/11/2008.

CARE HOMES FOR OLDER PEOPLE Comberton Nursing Home King William Street Amblecote Stourbridge West Midlands DY8 4EP Lead Inspector Sally Seel Key Unannounced Inspection 11th September 2008 08:30 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 Comberton Nursing Home DS0000060514.V371710.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. Comberton Nursing Home DS0000060514.V371710.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Comberton Nursing Home Address King William Street Amblecote Stourbridge West Midlands DY8 4EP 01384 262027 01384 76943 comberton@hotmail.co.uk 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. Jayantilal James Bhikhabhai Patel Mandy Coyne Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36), Physical disability (8), Terminally ill (8) of places Comberton Nursing Home DS0000060514.V371710.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate one named service user under the age of 65 years. Date of last inspection 15th May 2006 Brief Description of the Service: Comberton Nursing Home is located near to Stourbridge town centre. The home is sited in an attractive residential area. The home itself is a large detached property that has been converted and extended to its present form a 36 bedded nursing home. The home comprises of three storeys. Bedrooms are located on both floors. The main living areas, kitchen, offices, laundry and a shower room are on the ground floor, further bedrooms, the bathroom, toilets and the treatment room on the first floor. The lower ground floor accommodates the office and staff room. The home has well maintained gardens to the front and rear and a good sized car park at the front. Comberton is registered to provide care to a maximum of 36 residents who have nursing needs. Fees for the home range from £357.00 to £550.00 but please contact the home direct to ensure a correct figure is provided. Comberton Nursing Home DS0000060514.V371710.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. One inspector undertook this fieldwork visit to the home, over an eleven hour period. The registered manager and staff members assisted us throughout. The home did not know that we were visiting on that day. There were thirty one people living at the home on the day of the visit, with one person currently in hospital. Information was gathered from speaking to and observing people who lived at the home. Four people were “case tracked” and this involved discovering their experiences of living at the home. This was achieved by meeting people or observing them, looking at medication and care records and reviewing areas of the home relevant to these people, in order to focus upon outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and safety records were also reviewed. Prior to the inspection the registered manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave us some information about the home, staff and people who live there. Improvements and plans for further improvements, have been taken into consideration. Regulation 37 reports about accidents and incidents in the home were reviewed in the planning of this visit. Also nine completed surveys were received from people who live in the home together with three staff surveys and these were returned to CSCI. Information from both these sources was also used when forming judgements on the quality of service provided at the home. The people who live at this home have a variety of needs. We took this into consideration when case tracking four individual peoples care provided at the home. For example, the people chosen consisted of both male and female and have differing levels of care needs. Comberton Nursing Home DS0000060514.V371710.R01.S.doc Version 5.2 Page 6 The atmosphere within the home is inviting and warm and we would like to thank everyone for his or her assistance and co-operation throughout the day we visited. What the service does well: What has improved since the last inspection? The registered manager has produced a Statement of Purpose in large print which takes into account peoples varying needs and people are able to read information about the home to see if it is where they wish to live. The registered manager has devised care plans with risk assessments. These have the required contingency plans in them to ensure that people are not left at risk and peoples specific health and/or social needs are met. Comberton Nursing Home DS0000060514.V371710.R01.S.doc Version 5.2 Page 7 The manager is now registered with us and is showing a commitment to her role within the home to make further improvements to add quality to the lives of the people who live there. The registered manager has now developed a quality assurance system and is using the National Minimum Standards as a framework for this work and this will ensure positive outcomes for people. The home has worked towards meeting the majority of previous requirements and recommendations. This suggests that the providers and registered manager are keen to ensure that people who live in the home experience quality outcomes which comply with national minimum standards and regulations. 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. The summary of this inspection report can be made available in other formats on request. Comberton Nursing Home DS0000060514.V371710.R01.S.doc Version 5.2 Page 8 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 Comberton Nursing Home DS0000060514.V371710.R01.S.doc Version 5.2 Page 9 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): 1, 2, 3, 4 & 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides good information about the services it provides but needs to ensure that the Statement of Purpose and service user guide are reviewed on a regular basis to take into account of any changes or additions. People who wish to live at the home have an assessment of their needs giving assurance that staff are aware of peoples needs and can meet them. EVIDENCE: The home has a Statement of Purpose and a service user guide which tell people about what the home provides and how it might meet people health and social needs. These documents need some minor up dates and this was pointed out to the registered manager. The regsitered manager showed the inspector that these are now in large print so that people with visual impairments are able to read them. Comberton Nursing Home DS0000060514.V371710.R01.S.doc Version 5.2 Page 10 The statement of purpose and service user guide are on display by the nurses station in the home and when asked staff were able to show the inspector where these were kept. This means that the information is available to people if they choose to read it. The certificate of registration and public liability insurance certificate are on display and a copy of the previous inspection report can be found by the nurses station so that peole have access to this information should they wish to read it. Poeples contracts were being updated at the time of the homes inspection. One person told the inspector, “I signed my contract last year but I have not signed it this year”. This shows that people are issued with contracts and choice is respected when people do not wish to sign them. Care records that were sampled showed that comprehensive assessment of needs were in place prior to people coming to live in the home. This should give people the confidence that their individual health and social needs are able to be met by the staff practices together with the homes environment. In the Annual Quality Assuarance Assessment, (AQAA), completed by the registered manager, she states, ‘The latest assessment has included the family visiting the home and then a home visit by myself with the prospective client and two sisters’. People told us:• “I heard place was nice”. • “Known locally as the best in the district. Son visited and had no qualms to me living at Comberton”. • “I would not want to go anywhere else and I did look at some other places.” There is no intermediate care facility at the home. Comberton Nursing Home DS0000060514.V371710.R01.S.doc Version 5.2 Page 11 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 good. This judgement has been made using available evidence including a visit to this service. The revised care plans provides assurance that individual needs, choices and capabilities are known and will be met. Maintaining a consistent level of staffing will ensure peoples care needs are met in a timely fashion as people are waiting at times for care and attention. Medications are well managed and promote peoples health and wellbeing, although there needs to be some work undertaken with regards to homely remedies and administering medication in an enhanced hygienic way. People are treated with respect and their privacy upheld. EVIDENCE: Each person has an assessment of needs which informs written care plans. These individualised plans are about what each person can do independently Comberton Nursing Home DS0000060514.V371710.R01.S.doc Version 5.2 Page 12 and states what assistance is required from staff in order for needs to be met. We looked at four peoples care plans in detail and there is evidence of appropriate risk assessments with contingency plans in place. This was pleasing to see as it was a requirement made at the homes last inspection. The registered manager had developed these plans so that staff can identify risks to the person, how these should be managed and evaluated. Comments from staff surveys highlight, ‘care plans are updated monthly, new care plans added as required’. This shows that the home are monitoring and updating care plans to reflect peoples changing needs. Staff told us:• “The manager calls all the staff together to discuss new residents if special needs are required”. The AQAA told us that the registered manager is speaking with MacMillan nurses to provide some palliative care training for staff, so that ‘end of life’ care for people in the home is sensitively managed at this important time and care given is right for individual people. This is not only for the people who live in the home but for their family and friends. Also within care records there is evidence of peoples last wishes to make sure these are carried out at the time of peoples deaths. There was evidence of people receiving visits from external healthcare professionals including doctors, community nurses, dieticians and chiropodists. On the day of the inspection a visit was made to the home by a health care professional to take a persons blood for testing purposes. Also professionals in community rehabilitation therapy visited the home on the day of our inspection to provide people with activities to improve their physical abilities, particularly where people have experienced strokes. The management and giving of medication was observed in the morning. The nurse was observed to check the medication administration record (MAR) with each prescribed medication that she was giving to people. A ‘tot’, (small container), was used to give people their medication. However, the home should strongly consider using a spoon as some people cannot get their individual tablets out of the ‘tot’. This meant tablets were placed on tables by people and/or the nurse touched tablets at times. If a spoon or plates are used then people will be given their medication in a clean way. Good eye contact was made with people whilst medication was being given. The nurse told each person the individual name of the medication before it was given. The nurse was patient with people and gave them time to swallow their medications with an appropriate drink that people liked. The nurse took one persons pulse before giving the person their medication so that practice was in line with that type of person’s medical condition. The nurse made sure that people had taken their medication before signing the MAR sheet. A type of medication called ‘Lactulose’ had its prescribing label missing and therefore the Comberton Nursing Home DS0000060514.V371710.R01.S.doc Version 5.2 Page 13 nurse did not give this one to the person. Instead the nurse got another bottle that had clear prescribing label for the individual person from the treatment room as is good practice. There is a robust system in place for people who are on respite stay at the home. People’s medication is retained in their original containers from which staff give them to people which shows good practice and potential mistakes are lessened in this area. The registered manager checked a sample of people’s medication and a member of staff had given a person their medication but had not signed the medication administration records. The registered manager assured the inspector that this would be discussed with the member of staff the next day. All other medications that were checked were correct and reflect a robust system of giving medication so that people are protected from any possible medication errors. Staff were observed to assist people in a sensitive manner; staff were seen to be giving people choices about the food they ate and what they would like to drink. Staff assisted people from the table when they had eaten their meal to an area of the home that people chose to be in. Some people in the home felt that they sometimes had to wait long times for attention. The registered manager has made a note of this and will be looking into this specific area by completing ‘without warning checks’ within the home. The topic of privacy, dignity and respect is included in the induction training programme of staff. Observations throughout the day informed that people living in the home respond to staff and likewise in a comfortable and easy relaxed style. For example, people seemed to be well supported by staff to choose clothing appropriate for the time of year which reflects individual cultural, gender and personal preferences. Another example was, one person had their legs on a side table but when asked by staff whether they were comfortable the person stated they were. Staff respected this person’s choice and provided the person with some pillows to ensure that their leg, ankles and feet did not have pressure placed on them by the hardness of the table. Also staff were seen to knock on people’s room doors before entering and use peoples preferred names. The home has a mix of single and double rooms, each door being fitted with a privacy lock and double rooms have privacy curtains. People told us:• “Fantastic hospital visits as X is always taken by a member of staff and looked after 100 ”. • “You only have to ask and if it’s at all possible it will be done straight away if not sooner”. • “Care is much better here than the other home I went to and I do not Comberton Nursing Home DS0000060514.V371710.R01.S.doc Version 5.2 Page 14 • • want to move from here”. “I have to wait on the toilet for staff and it can seem like a long time.” “Staff are very busy and they cannot always see to your wants straight away.” Comberton Nursing Home DS0000060514.V371710.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made using available evidence including a visit to this service. People are able to choose the activities that they participate in which promotes their individuality and independence. People are offered a choice of meals to meet their dietary, cultural needs or preferences. Meals and menus need reviewing further to ensure the standard and quality of these meet differing peoples tastes. EVIDENCE: There is an activities coordinator employed by the home and there are a range of activities for people to take part in if they wish. For example, bingo, quiz time, manicures, art and craft work, exercise to music, poetry corner, hand and face massage. Time is set aside for ‘one to one’, which means that people can have time on their own with the activity coordinator to make sure activities they receive are appropriate and that they can continue their chosen interests. This may be for people who stay in their rooms or people who prefer not to join in larger group activities. Comberton Nursing Home DS0000060514.V371710.R01.S.doc Version 5.2 Page 16 There were photographs’ displayed in the home of events that had been held which included the homes own fetes. One person in the home has recently had Sky television installed in their room. This means that this person can watch all the sports channels which they used to enjoy when living at home. People told us:• “Singers, jewellery, summer fair/autumn fair, organist, fashion shows, shopping trips, JP (activities coordinator), is fantastic 100 ”. • “Choose not to take part”. There is an open visiting policy, which means people can see their visitors as they choose and maintain relationships that are important to them. People were seen to visit throughout the day. If people choose to they could take their visitors into the ‘quiet room’ where there is privacy and space for people to engage in conversation with their visitors. Staff were seen to bring people and their visitor’s drinks as required. The home has a four week rotating menu and menus are displayed in the entrance hallway of the home and staff were seen asking people what they would like for their meals. There is a choice of a cooked breakfast if people want this and a choice of two hot meals at lunchtime. At teatime there is a choice of a hot snack or sandwiches. Supper is offered with a hot drink and snacks throughout the day. The home is able to cater for special diets for reasons of cultural or medical needs. On the day of our visit the menu was as follows:1. Breakfast – grapefruit and prunes or assorted cereals or boiled or poached egg, bacon, sausage, or kippers, tomatoes, beans or toast and various preserves, tea or coffee 2. Lunchtime – Liver and onions with potatoes, vegetables or sausage with onion gravy. For pudding – bread and butter pudding 3. Teatime – beans or tomatoes’ on toast or a sandwich. Jelly and ice cream for dessert. There is also a choice of alternatives if people do not like the menu for that particular day. Generally there appears to be a good variety of meals on offer with the added alternatives if people wish. The stock cupboard/larder where food supplies are kept is substantially stocked with varying varieties with brand names also. The breakfast and lunchtime meals were observed on the day of the visit. The tables were nicely laid and the atmosphere was calm. If people required some assistance with their meals this was undertaken by staff members with dignity and in an unhurried way. Comberton Nursing Home DS0000060514.V371710.R01.S.doc Version 5.2 Page 17 The menus are on display in the entrance hallway of the home and staff were seen asking people what they would like for their meals. Some people in the home told us that the meals needed reviewing as they were not always cooked to their liking. The registered manager is now having discussions with the cooks and has already taken some suggestions from people on their food preferences including variety of meal options. People living in the home have been asked to also write down any food suggestions as they think of them if they are able and/or are encouraged to express these. In the completed AQAA this is also echoed by the registered manager, ‘To analyse the results of the mealtime survey and act upon any highlighted areas’. This shows that the registered manager and staff are listening to people’s wishes in respect of improving the meals further within the home. This should benefit individual peoples nutritional needs which require balancing with peoples choices in respect of their likes and dislikes in meals. People told us:• “X is a finicky eater. Loves his cooked breakfast, cooked dinner and his tea with his son X”. • “Very hit and miss – more miss than hit”! • “No complaints.” Comberton Nursing Home DS0000060514.V371710.R01.S.doc Version 5.2 Page 18 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, 17 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service have their views listened to and acted upon. People are protected from harm and staff recognise signs of abuse and know how to deal with it. EVIDENCE: The complaints procedure is included in the homes statement of purpose and service user guide so that people know how to make a complaint if they need to. We have received one complaint that has been referred to the registered manager. This complaint was mainly in relation to the person having to wait a long time for staff and confirmed to us that there was not enough staff working in the home at times. Also meals were not being cooked to this persons taste and there needs to be more variety on offer. On the day of our inspection this was looked at further with the person who made this complaint and it was agreed that the registered manager is to look into this complaint further and respond appropriately. The person is happy for the registered manager to look at their complaints in the first instance. People told us:Comberton Nursing Home DS0000060514.V371710.R01.S.doc Version 5.2 Page 19 • “See matron or nurse in charge and 99 times out of 100 the problem is solved in minutes. Brilliant” • “Dad would complain to X who would speak to matron or senior nurse. At present X have never had to complain”. The home has local multi-agency guidelines for staff to follow which assists in the event of an allegation of abuse. There had been one incident in the home whereby a staff member had given a person the wrong medication by mistake. This was looked into and was appropriately dealt with by the home and the case had now been closed. The member of staff no longer works in the home. This means that the home is acting appropriately and people are protected from harm. Staff had received training in safeguarding procedures so that they should know what to do in the event of an incident or allegation being made, to ensure people are safe. Staff spoken with on the day of our inspection could give examples of forms of abuse and what they would do if they witnessed abuse within the home. This shows that people can be confident that staff at the home have the knowledge to protect people from harm. Staff told us:• “Would see matron if I saw any abuse.” • “Would see matron and it would be reported to social services and police.” • A number of people recalled that they had voted at the last elections using postal ballots. In the AQAA the registered manager has stated, ‘Residents are encouraged to maintain any political beliefs they have and current affairs is sometimes found on the activity agenda. Residents are on the electoral role and are assisted to vote if they do so desire’. This means that peoples rights are upheld as citizens in their preferred choices. Advocacy services and leaflets are on display in the home should people choose to use this service. This means that the home has considered the support some people may require in living their lives. Comberton Nursing Home DS0000060514.V371710.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, 23 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with a homely, clean and comfortable environment in which to live where their privacy is maintained. EVIDENCE: A partial tour of the home was undertaken; communal areas were looked at and a sample of some of the bedrooms and bathing facilities relevant to people we case tracked. The atmosphere was calm, relaxed and friendly and there were no unpleasant odours. The home has two lounge areas and the larger lounge area has the dining area incorporated into it. In the larger lounge there is a new plasma type television Comberton Nursing Home DS0000060514.V371710.R01.S.doc Version 5.2 Page 21 which has been given to the home by a family to thank the home for the care their loved one received there. The home also as a small quiet room where people can sit and meet with their visitors if they so wish. The carpets were cleaned and all flooring was appropriate to minimise any falls. One person told us, “The first thing once you’ve set foot in the door of Comberton is how fresh it smells clean and tidy fantastic 100 ”. Bedrooms were personalised and reflected individual tastes, gender and cultural preferences. People are encouraged to bring in their own possessions in order to have familiar items around them to make their rooms as homely as possible. The home has a sluicing disinfector and adequate laundry appliances. Liquid soap, paper towels, gloves and aprons were seen in all high risk areas. There was no evidence of communal items being used in toilets or bathrooms which is good practice in reducing risks of cross infection. In the AQAA the registered manager is working on completing guidance called ‘Essential Steps to Safe Clean Care’ and also to providing distance learning course for care staff in infection control to commence later in the year’. The kitchens were clean and all aspects of hazard analysis and critical control points were in place to provide a safe food production area. The homes handyman continues to maintain both inside and outside the property. Where required they speak with external contractors. The handyman continues to perform monthly checks on equipment within the home and ensures defects are repaired or replaced. There is evidence of a robust maintenance folder kept by the home as recorded evidence and for checking purposes. The homes garden is well maintained and a pleasant area for people to sit if they so wish. Comberton Nursing Home DS0000060514.V371710.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. This judgement has been made using available evidence including a visit to this service. People are supported by staff who receive training but this now needs to be consistently maintained to ensure staff have up to date knowledge to meet individual needs. Staffing levels need to be maintained sufficiently on a consistent basis to ensure that people’s needs are met in an efficient way. The recruitment procedure is robust and ensures that people are safeguarded from harm. EVIDENCE: There were six care staff and two trained nurses on duty on the day of our inspection. At weekends there are five care staff and one trained nurse on duty. The home also employs kitchen staff (there are two cooks), domestic, laundry, maintenance and administrative staff to ensure that all aspects of peoples needs are met whilst living at the home. Staff told us:• “I like it here and we work as a team. There have been three new carers recently employed”. Comberton Nursing Home DS0000060514.V371710.R01.S.doc Version 5.2 Page 23 • “In my opinion the service is run very well. Occasionally short staffed but on most occasions a carer is found”. The registered manager is aware that she needs to sustain the current staffing levels and is working hard to achieve this, as she states in completed AQAA, ‘Maintain a good group of flexible permanent staff’. People told us:• “Always short staffed, particularly at weekends and holiday periods. However, the majority of the care staff are excellent, as are the nurses, despite having to work in an under-staffed environment”. • “Have to wait for a long time on the toilet until care staff come to assist”. At present the registered manager is short of a deputy to support her in the task of making ongoing improvements in the home to ensure the best possible outcomes for people who live there. Therefore it is strongly recommended that the home gives some consideration to employing a deputy manager. There is evidence that 70 of staff have completed a National Vocational Qualification, (NVQ), Level 2. This is above the recommended standard and shows there is a good ethos in the home of enabling staff to have this type of qualification. There are also a variety of training courses booked for later this year which include safe handling of medicines, infection control, manual handling updates, health and safety updates, health and safety awareness training, food hygiene and abuse awareness. The registered manager is to also complete, ‘Dudley’s Dignity in care’, programme. This should ensure that the home invests in a knowledgeable and skilled workforce that is able to meet the varying needs of the people who live there. Two staff records were reviewed and were found to contain all of the relevant information including two written references, POVA first checks (Protection of Vulnerable Adults) and CRB checks (Criminal Records Bureau). Staff had been provided with job descriptions and there was evidence that people receive an induction into the home so that they are aware of their responsibilities. Records were well organised and information was easy to retrieve. This provides confidence for the people who live in the home that they will be protected by the home employing and training staff to meet their needs effectively. Staff were observed engaging with people and seemed to understand people’s needs together with what needs to be done to meet these in an appropriate way. The atmosphere in the home was friendly and staff were seen to greet people in a warm way. Comberton Nursing Home DS0000060514.V371710.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, 36 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager has strong leadership skills and is competently striving to make improvements in the best interests of the people who live at the home. Staffing levels need to be consistently maintained as people living in the home are highly dependant upon staff to meet their needs at all times. EVIDENCE: This was the registered manager, Mandy Coyne, first inspection since she came into post and she has made a number of improvements to the home. The registered manager is clear about further changes she would like to make in order to ensure that the home is run in the best interests of the people who Comberton Nursing Home DS0000060514.V371710.R01.S.doc Version 5.2 Page 25 live there. Staff members who were spoken with on the day of the inspection appeared to value the input that they receive from their manager. Staff commented on their managers ‘open door’ policy for any concerns or issues they may have at any given time. As mentioned in the ‘staffing section’ of this report it is important that staffing levels are consistent to ensure that people’s needs are met and their choices are upheld. In view of this the home is strongly recommended to maintain the consistency in the staffing levels at all times to meet the dependency levels of the people who live in the home. In previous inspections this is an area that the home has needed to focus upon. Staff told us:• “At the present time there are six staff members on duty and hopes that this can be maintained in the longer term”. • “Two nurses are needed at weekend’s as well as on a weekday”. Residents and staff meetings are held so that people have the opportunity to voice their concerns and suggestions for improvements. The proprietor visits the home and completes Regulation 26 visits, these report on the quality of service being offered to the people at the home. For example, any complaints or compliments, staffing issues, maintenance issues in the home and so on. The registered manager has now developed her own quality assurance record keeping which is based around the national minimum standards framework to make sure positive outcomes for all the people who live in the home are met. In addition to this there is evidence of surveys completed by people who live in the home and these were dated 2008. There were also staff surveys which were completed in December 2007. It would now help the registered manager greatly if she had a deputy manager to assist in taking the home forward in its improvements. This would further improve the quality of living for people within the home. At the homes last inspection there was a requirement made to update health and safety policy for safe working practices with risk assessments of workplace activities. The registered manager is developing this now and therefore we can be satisfied that this requirement is being complied with but needs to be regularly reviewed. The AQAA that the registered manager had completed gave us very comprehensive and detailed information about the home, staff and people who live there, improvements and plans for further improvements. This was taken into consideration and some of the registered managers comments can be found within this report. The registered manager provided some good examples as follows:‘The activities co-ordinator currently offers facial massages which is not only popular with the female residents but is welcomed by a male resident whom it Comberton Nursing Home DS0000060514.V371710.R01.S.doc Version 5.2 Page 26 helps to relax, he is always offered the choice and as with every other resident choice is respected.’. The home does not act as appointee for people but assists with personal allowances, the records of which are completed thoroughly. Individual records are maintained for people where the home holds personal monies. Receipts were available to confirm all expenditure on peoples accounts. The balance of monies checked was found to be correct, with two signatures for all entries. This should ensure that people’s monies are held safely. People do have the choice to manage their own finances. For instance, one person has chosen to keep their own cheque book. Therefore the home has completed a risk assessment which is kept with the persons care records. There was evidence that health and safety maintenance checks had been undertaken in the home to ensure that all equipment was in safe and full working order. For example, maintenance checks are completed on the fire system and equipment so that people should be safe in the event of a fire occurring. The manager produced an audit of accidents and these are reviewed to monitor any trends that are occurring. This means that the home are going some way to lessen the risks associated with accidents particularly with the reference to the audit being a good indicator of potential trends. This is positive for the people who live in the home and staff alike as it is protecting all people from unnecessary risks of injuries and/or harm. Comberton Nursing Home DS0000060514.V371710.R01.S.doc Version 5.2 Page 27 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 3 2 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X X 2 X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 X X 2 Comberton Nursing Home DS0000060514.V371710.R01.S.doc Version 5.2 Page 28 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. 2. OP30 Standard Regulation 18(1)(c) (i) Requirement All staff need to have up to date training in handling and administrating medication safely and/or refresher training as appropriate. This is to promote the safe handling and giving of medication thus protecting peoples health needs. Timescale for action 11/11/08 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. OP15 2. OP27 Refer to Standard Good Practice Recommendations The home should keep the menus under regular review ensuring service users wishes are incorporated in the choices. It is strongly recommended that there is some consideration to the home employing a deputy manager to assist the registered manager in discharging some of her duties and assisting with further improvements that need to be made. This will further enhance the best possible outcomes for people and ensure effective leadership at all times. DS0000060514.V371710.R01.S.doc Version 5.2 Page 29 Comberton Nursing Home Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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. 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