CARE HOMES FOR OLDER PEOPLE
Cooksditch Residential and Nursing Home East Street Faversham Kent ME13 8AN Lead Inspector
Tina Thomas Unannounced Inspection 17th January 2006 10.00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cooksditch Residential and Nursing Home DS0000023399.V279159.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cooksditch Residential and Nursing Home DS0000023399.V279159.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Cooksditch Residential and Nursing Home Address East Street Faversham Kent ME13 8AN 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) 01795 530156 Mrs Gillian Heather Ilsley Care Home 55 Category(ies) of Old age, not falling within any other category registration, with number (55) of places Cooksditch Residential and Nursing Home DS0000023399.V279159.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. DE(E) is restricted to those persons whose dates of birth are 08/01/1922, 26/05/1931, 23/05/1915, 21/10/1914, 27/10/1912, 15/10/1913. LD(E) is restricted to one (1) person with a date of birth of 07/09/1938 6th September 2005 Date of last inspection Brief Description of the Service: Cooksditch House is a large detached property situated in the centre of Faversham. The original house is a grade 2 listed building. It offers care to up to 55 people. This includes up to 35 Older people with nursing needs, 19 Older people and One Service User with a learning difficulty. The home has a variation of registration to care for 6 of the older people that now come within the Dementia category. Buses stop outside the Home. There is a local park and church within a few minutes walk of the Home. The Home has two lifts to enable access to all the areas. Accommodation is provided in both single and double rooms many of which offer en-suite facilities. All bedrooms have a call bell system and television point in situ. Cooksditch Residential and Nursing Home DS0000023399.V279159.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection conducted over a one day period. The main aims of the inspection were to assess key standards that were not assessed at the announced inspection of 6/9/05 and to ensure that any requirements or recommendations made at that time have been met. The inspection was conducted with the assistance of Tina Blackmore, Tina has applied to the Commission to be registered as the manager. The application is currently in process. The home was registered in September to accept Service users requiring nursing care. The home now has a number of trained nursing staff. The staff have adapted to having nursing service users. The home continues to meet the needs of, and care for, all the people who currently live in the home on a residential basis, taking in people with nursing needs only as rooms become vacant and available. Improvement to the environment is ongoing. There have been improvements in one bathroom and carpeting is gradually being replaced. The home has created a room where people living in the home or their relatives can speak privately with the staff, care managers, doctors etc. All improvements are of good quality. What the service does well: What has improved since the last inspection? What they could do better:
Cooksditch Residential and Nursing Home DS0000023399.V279159.R01.S.doc Version 5.1 Page 6 Care plans are generally of good quality. Although, the monthly reviews are not always properly performed and staff write comments such as ‘care plan remains relevant’ each care plan has a number of goals. One may be, for example, for a service user to remain continent. The review should reflect on the goal, to see if methods used to aid the goal have been successful. Therefore comments such as ‘care plan remains relevant’ are of no quality. Some entries in care plans have been scored through or scribbled out. This is not best practice. Documentation may be called on at a later date, for legal reasons for example a coroner may wish to view documentation, therefore documentation must not be defaced. As part of the recruitment process the Manager does face-to-face interviews before employing staff. There is no evidence of this, as the manager does not retain the notes. Keeping records of these interviews is recommended. The home has a policy regarding the holding of service users money. The policy should be strengthened to reflect what is the upper limit of money to be held, what happens when this limit is reached and to reflect the practice of double signing. 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. Cooksditch Residential and Nursing Home DS0000023399.V279159.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cooksditch Residential and Nursing Home DS0000023399.V279159.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection. At the inspection of 6/9/05 standards 1-5 were met. The home does not offer the care described in standard 6. EVIDENCE: Cooksditch Residential and Nursing Home DS0000023399.V279159.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, Care plans describe people’s health, personal and social care needs. Standards 8-10 were not assessed at this inspection. At the inspection of 6/9/05 they were all met. EVIDENCE: A number of care plans were viewed. They are generally of good quality. They were well written, and held appropriate information to enable staff to care for the people who live in the Home. Suitable risk assessments are in place to ensure as far as reasonably practicable the safety of people living in the home. A number of instructions had been either scored through inappropriately or scribbled through. A recommendation has been made that staff refrain from this practice as it defaces documentation that may need to be viewed at a later date. Recommendation 1 Part A It was noted that when the care plans were reviewed staff would write comments such as ‘care plan remains relevant’ A recommendation has been made that reviews of care plans should reflect on the goal. Recommendation 2 Part A Cooksditch Residential and Nursing Home DS0000023399.V279159.R01.S.doc Version 5.1 Page 10 The home had a complaint regarding one service user having dirty nails. The home has supplied each carer with a manicure kit and staff will be having a teaching session from an external manicurist on nail care. Cooksditch Residential and Nursing Home DS0000023399.V279159.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 Meals are wholesome and appealing. Standards 12-14 were not assessed at this inspection. At the inspection of 6/9/05 they were met. EVIDENCE: The inspector spoke with people who live in the home who expressed that the food was of good quality. Meals are taken in one of the two attractive dinning areas or in peoples own rooms. The kitchen fridge is broken and vegetables are now being stored in a corridor outside of the kitchen. A requirement has been made that the Provider finds a solution to the lack of refrigeration. Requirement 1 Part A Cooksditch Residential and Nursing Home DS0000023399.V279159.R01.S.doc Version 5.1 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Service users are protected from abuse. Standard 16 was assessed at the inspection of 6/9/05 and was met. EVIDENCE: Staff have training in the prevention of adult abuse during induction, and foundation training. They also cover it in NVQ Level 2 training. The home has a whistle blowing policy. Criminal Records Bureau Checks are applied for prior to Staff commencing employment. Cooksditch Residential and Nursing Home DS0000023399.V279159.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,26 Service Users live in a safe and well-maintained environment. People have access to safe indoor and outdoor communal facilities. The Home is clean pleasant and hygienic. EVIDENCE: As evidenced in the previous report, the registered provider continues to improve the environment. On the day of inspection new carpet was waiting to be laid in the hallway. The home has created a room where people living in the home or their relatives can speak privately with the staff, care managers, doctors etc. The inspector noticed a number of small repairs that needed undertaking. These were reported to the maintenance man and completed prior to the end of the inspection. The home has a number of communal areas, including three sitting rooms that are all domestic in nature. In one lounge there was lots of conversation between the people who live there. There were also a number of visitors. The
Cooksditch Residential and Nursing Home DS0000023399.V279159.R01.S.doc Version 5.1 Page 14 home has a sun lounge, which leads to the courtyard. The inspector observed a number of people enjoying this area. Both dinning areas are attractive and inviting. The home has an activities room. Space has been created for the suitable storage of wheel chairs, hoists and other aids. At the last inspection it was identified that one bathroom needed some redecoration. A requirement was made that the necessary work to the bathroom be completed by March 06. The work was not completed at the time of inspection, which was conducted prior to the date agreed. The inspector understands that at the time of writing the report the bathroom suite has been renewed and decoration is near completion. The home has also provided another new assisted bathroom. Incorrect signs identified at the last inspection have been removed from doors. When entering the building the inspector found that there were several clinical waste bags thrown in the courtyard next to the clinical waste bin they should have been put in. The inspector discussed this with the Manager and they were promptly removed. Staff must ensure that this does not reoccur. The home is generally very clean and free from offensive odours. Cooksditch Residential and Nursing Home DS0000023399.V279159.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 The home has robust recruitment policies and practices. Standards 27and 30 were assessed at the last inspection and were met. Standard 28 was nearly met. EVIDENCE: Staff files were viewed. They were well maintained. They contained an application form, references, proof of the carer’s identity and proof of training in the form of certification. All staff have a current CRB check. All staff have a face-to-face interview with the Manager before being accepted for employment. A recommendation has been made that the manager takes interview notes at these interviews. Recommendation 3 Part A Cooksditch Residential and Nursing Home DS0000023399.V279159.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35 The Manager is experienced and well trained. Service users financial interests are safeguarded. Standards 32,33,34,36,37,and 38 were not assessed at this inspection. At the inspection of 6/9/05 they were all met. Standards 32,33,34,36,37,38 were not assessed at this inspection. At the inspection of 6/9/05 they were met. EVIDENCE: The Manager, Tina Blackmore is a Level 1 registered nurse. She has completed N.V.Q Level 4 in Management has achieved the Registered Managers Award. She has attained the ENB 931 palliative care certificate. Tina has completed dementia training facilitated by the Alzheimer’s society. She is currently in the 2nd year of a social care and welfare degree. She has applied to the Commission for registration as the Manager of Cooksditch. The home looks after small amounts of money for some service users. Any transactions are double signed. The home has a policy regarding service users
Cooksditch Residential and Nursing Home DS0000023399.V279159.R01.S.doc Version 5.1 Page 17 money. The policy should be strengthened to reflect what is the upper limit of money to be held, what happens when this limit is reached and to reflect the practice of double signing. Recommendation made regarding this matter. Recommendation 4 Part A Cooksditch Residential and Nursing Home DS0000023399.V279159.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 3 3 3 3 x x x 3 STAFFING Standard No Score 27 x 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x x x 3 x x x Cooksditch Residential and Nursing Home DS0000023399.V279159.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP15 Regulation 23 Requirement The Provider must find a solution to the lack of refrigeration. Timescale for action 17/03/06 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 2 3 4 Refer to Standard OP7 OP7 OP29 OP35 Good Practice Recommendations Staff should not deface documentation by scoring through, or scribble out. Reviews of care plans should reflect on the goal The manager should retain interview notes The homes policy pertaining to service users finances should be strengthened Cooksditch Residential and Nursing Home DS0000023399.V279159.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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