Inspection on 17/09/08 for Cooksditch House Nursing and Residential Home

This inspection was carried out on 17th September 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cooksditch House Nursing and... 31/03/08

Cooksditch House Nursing and... 27/09/07

Cooksditch House Nursing and... 30/05/07

Cooksditch House Nursing and... 18/05/06

Cooksditch House Nursing and... 17/01/06

Cooksditch House Nursing and... 06/09/05

Cooksditch House Nursing and... 11/03/05

Cooksditch House Nursing and... 03/06/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

CARE HOMES FOR OLDER PEOPLE Cooksditch House Nursing and Residential Home East Street Faversham Kent ME13 8AN Lead Inspector Anne Butts Unannounced Inspection 10:00 17 and 18 September 2008 th th 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 House Nursing and Residential Home DS0000023399.V372359.R02.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. Cooksditch House Nursing and Residential Home DS0000023399.V372359.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cooksditch House Nursing and Residential 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 Ilsley Vacant Care Home 55 Category(ies) of Old age, not falling within any other category registration, with number (55) of places Cooksditch House Nursing and Residential Home DS0000023399.V372359.R02.S.doc Version 5.2 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 with 1 under the age of 65 - 24/10/1943. LD(E) is restricted to one (1) person with a date of birth of 07/09/1938 31st March 2008 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. 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. The fee range for residential is £326.33-£488.00 and £445.28£583 for nursing excluding the RNCC. (The nursing element) Cooksditch House Nursing and Residential Home DS0000023399.V372359.R02.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 1 star. This means the people who use this service experience adequate quality outcomes. This was a key unannounced inspection that took place over the course of 2 days on the 17th and 18th September 2008. The main focus of the visit was to review any improvements made since the last visit and review the key standards and associated regulations for Older Persons. We (The Commission) spent time touring the building, talking to people living in the home, talking to staff and reviewing a selection of assessments, service user plans, medication records, menus, staff files and other relevant documents. We sent out surveys to people living in the home, staff and healthcare professionals and feedback from these have been used to inform our inspection process. We also spoke to representatives of the purchasing authority (Kent County Council) and the Primary Care Trust to gain their views of the service provided. As part of this inspection we were accompanied by an Expert By Experience, this is someone who has knowledge of the needs and issues that are important to older people. The Expert By Experience spent time talking to people living in the home, relatives who were visiting and observing lifestyles. It is now a legal requirement for services to complete and return an Annual Quality Assurance Assessment (AQAA). The home had completed their AQAA earlier in the year, and information from this was used to inform the inspection. Judgements have been made with regards to each outcome area in this report, based on records viewed, observations, verbal responses given and information in the returned surveys. These judgements have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable The Commission for Social Care Inspection (CSCI) to be able to make an informed decision about each outcome area. Further information can be found on the CSCI website with regards to the IBL process including information on KLORA’s and AQAA’s. The home is registered to provide care for people with both residential and nursing care needs, with people primarily occupying different ‘sides’ of the building. People are able to access the communal areas as they wish. For the purpose of this report we will refer to the different services provided as nursing care or residential care. Cooksditch House Nursing and Residential Home DS0000023399.V372359.R02.S.doc Version 5.2 Page 6 The owner has appointed a person to run the home on a day to day basis in the position of manager. They are not registered with the Commission, but have been referred to as ‘the manager’ within this report. What the service does well: What has improved since the last inspection? The Statement of Purpose has been reviewed and is now clear about the range of needs, which they can meet. It also identified how they will support people with any changing needs. The admissions assessment process has improved, with sufficient information being obtained so that the home can make a judgement as to whether they can meet individual needs. Where care plans have been updated, particularly in the nursing unit, there is more detailed person centred guidance. However not all care plans have benefited from this process. Health care monitoring has improved including the healthcare support needed to support people with their dietary and behavioural management needs. The system for assisting people with the management of their personal monies is now more robust. Cooksditch House Nursing and Residential Home DS0000023399.V372359.R02.S.doc Version 5.2 Page 7 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. Cooksditch House Nursing and Residential Home DS0000023399.V372359.R02.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 Cooksditch House Nursing and Residential Home DS0000023399.V372359.R02.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, 3, 4, and 6 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 sufficient information to be able to make an informed decision about moving into the home. Progress has been made to improve the admissions procedure to ensure that there is a proper assessment for people moving into the service. EVIDENCE: At our last visit we (The Commission) saw that the home’s Statement of Purpose did not accurately detail the range of needs and the services provided by the home. A requirement was made in relation to this so that prospective residents will be able to make an informed judgement as to whether they feel the home will meet their needs. We looked at the updated Statement of Purpose and saw that this now contained details about the range and needs of the people they can accommodate in the home. Cooksditch House Nursing and Residential Home DS0000023399.V372359.R02.S.doc Version 5.2 Page 10 When a new resident moves into the home a pre-admission assessment is undertaken. In the residential unit this is carried out by a senior member of staff and in the nursing unit these are carried out by a senior nurse. We looked at admission process for new residents in both units. We saw that the pre-assessments contained sufficient detail for the home to assess as to whether they could meet individual needs. They included information on personal hygiene needs, medication, nutrition, moving and handling and social needs. We saw that the assessments took into account individual needs and gave people the opportunity to participate in this process. In the residential unit the home still needs to continue to make sure that all details are fully completed. In the nursing unit the home has been receiving support from the clinical specialist nurses from the Primary Care Trust (PCT). Feedback from them supported that the admissions process for people with nursing needs had improved. They have been supporting the nurses in the home with training and the assessment process and people with nursing needs are only admitted if the home can meet individual needs. At the last visit a requirement was made that the home makes sure that any changing needs of the people living in the home are identified and appropriate referrals are made especially with regards to any mental health needs. The manager confirmed that this is occurring and that they are actively seeking appropriate healthcare intervention where changing needs dictate. The home does not provide intermediate care, but will provide people with short respite care. Cooksditch House Nursing and Residential Home DS0000023399.V372359.R02.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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all care plans identify individual needs and give clear guidance to staff. People are not adequately protected by the Home’s storage, administration and recording of medication. EVIDENCE: We looked at six care plans, three from the residential unit and three from the nursing unit. We also looked at specific sections of those individual care plans to review progress made in relation to requirements made at the last visit. On the residential unit, the care plans varied in quality with some containing more detail than others. A care plan for a new resident contained more detail and supported how the person wanted assistance with their needs, and this was supported by individual risk assessments. However, the two other care plans we viewed did not contain this level of detail and where an assessment Cooksditch House Nursing and Residential Home DS0000023399.V372359.R02.S.doc Version 5.2 Page 12 indicated a higher level of care need – this information was not always placed into the actual care plan guidance for staff. For example a review had been carried out for an individual mobility need where this information identified a change in support – this had not been placed in the care plan guidance for staff. In the nursing unit, the care plans have continued to be developed and we saw that where these had been completed they contained more detailed guidance supported by risk assessments. For example a care plan supporting a person with their mobility needs identified what the person could and could not manage and how to use the hoist and sling when assisting the person. This gave staff clear guidelines on supporting the person safely. However we also saw that in one care plan the care needs assessment identified that there were thirteen areas of care and support that the person needed assistance with. The actual care plan guidance only contained information relating to six of these areas, therefore not giving accurate and clear details on how to fully support the person with all their needs. We also saw that where care plan guidance had been updated in some instances the accompanying assessment process had not been completed. We saw in another care plan that where assessments had been reviewed this information had been placed into current care plan guidance. At our last visit we had concerns regarding the assessments and ongoing support for people with any behavioural monitoring. We saw at this visit that appropriate behavioural charts were now being used, and action taken through multi-disciplinary protocols in order to support people with identified needs. At the last visit we also had concerns with regards to nutrition and how people are supported with specialist needs. We saw that this had also improved with more robust monitoring of peoples nutritional needs and where appropriate food and fluids charts are put into place and used as a working tool to monitor and support the individual. Where there are concerns then healthcare intervention is sought. Skin integrity and pressure areas are monitored and appropriate pressure relieving equipment is put into place where a need indicates. Feedback from relatives and a care manager also confirmed that where a healthcare need was identified then these were acted upon appropriately with action taken. During the last year the home and particularly the nursing unit has worked closely with the Primary Care Trust (PCT) to develop documentation and care practices based on good practice guidelines. Feedback from the PCT evidences that there have been improvements and that the further development of team nursing along a clear pathway of person centred care which is reflected in both Cooksditch House Nursing and Residential Home DS0000023399.V372359.R02.S.doc Version 5.2 Page 13 care delivery and in their planning and evaluation of care, will further benefit the people living in the home. At the last visit we also made a requirement relating to medication. Following this as part of the safeguarding vulnerable adults procedures the home has been working with the Local Authority and PCT to improve procedures and policies within the home. Since our last visit there have been further medication errors, both in the nursing and residential units and not all of these have been reported to us (The Commission) in accordance with regulations. In the nursing unit we saw that the recording of medication had improved with a spot check on a selection of the Medication Administration Record (MAR) sheets not showing any gaps. Where MAR sheets needed handwritten prescription guidelines, these were not always signed by two people to confirm that the details were correct – this should be done as good practice to further safeguard people and a recommendation has been made. The Senior Nurse on duty at the time of our visit had just taken over responsibility for the management and auditing of medication. She was knowledgeable in good practice for the adminsitration of medication and was in the process of implementing improved auditing and monitoring procedures. In the residential unit we saw that there were monitoring and auditing systems in place and prior to our visit the Home had identified that there had been a series of medication errors. The manager confirmed that action had been taken and a full investigation carried out and this had identified that a member of agency staff had been responsible for this. We spot checked sixteen boxes and saw that there were three boxes which did not tally with the amount of tablets entered as being administered – this however was in the same time period as the medication errors identified prior to our visit. We also evidenced that not all medication was being stored correctly in that where medication was dispensed from the pharmacy in sealed units, some of these seals had been broken. This could result in the tablets either falling out of the unit or becoming contaminated. The manager, together with feedback from the safeguarding adults team, has shown to us that the medication errors are primarily carried out by staff who are employed on a temporary basis through an agency. It is the Registered Providers responsiblity to make sure that all staff employed at the home are competent in the work they are to perform and the Registered Provider must make sure that any staff administering medication are adequately trained and have been given the appropriate induction in order to carry out these duties. A requirement is being made that only trained and competent staff are to administer medication. Feedback from the PCT and the safeguarding adults team state that there needs to be a more robust internal audit of safety issues, particuarly around medication, and the home needs to continue to develop this. Cooksditch House Nursing and Residential Home DS0000023399.V372359.R02.S.doc Version 5.2 Page 14 People’s individual preferences about getting up or going to bed are respected and at all times during our visit we saw that staff interacted well with people and listened to what they had to say. People living in the home spoke highly of the staff and comments included “the staff are really dedicated and always polite and kind” and “staff here are wonderful – they really care”. We saw that at all times staff treated people with respect and courtesy, and information from relatives, Care Managers and the PCT also supported that they had observed staff to treat people with respect. Cooksditch House Nursing and Residential Home DS0000023399.V372359.R02.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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People mainly benefit from being supported by an activities co-ordinator who has implemented a range of social activities. People benefit from being encouraged to maintain contact with relatives. People also enjoy a balanced diet with home cooked meals that offer choice and cater for special diets. EVIDENCE: There is a dedicated activities co-ordinator, who works 30 hours per week. The activities co-ordinator spends time organising group activities or individual one-to-one sessions. On the day of our visit the Expert By Experience spent time talking to the activities co-ordinator, people who live in the home and visiting relatives. Group pastimes include games, quizzes, bingo and keyboard sessions. On the first day of our visit the Expert By Experience observed a word recognition Cooksditch House Nursing and Residential Home DS0000023399.V372359.R02.S.doc Version 5.2 Page 16 activity which all members of the group appeared to enjoy. Outside entertainers are arranged and we also saw that on one day a barbeque had been organised and there was a duo playing music. Entertainers also visit once a month and local schools and choirs visit at Christmas. Individual pastimes include massage and nail painting. People are escorted to local shops and 1 lady also regularly visits the local Age Concern Day Centre. Feedback about the opportunities to participate in activities was mixed with a returned survey stating “the activities co-ordinator always has time for all the residents” but another survey stated, “Cannot participate due to my disability”. A visitor also stated that their relative “was left alone too much” and someone else commented that “My relative is encouraged to join in, but sometimes prefers not to and their wishes are respected”. The activities co-ordinator confirmed to the Expert By Experience that she tries to spend time with all the people in the home wherever possible and where people are confined to be for reasons of ill health, she will visit them in their rooms. We saw that care plans identified people’s individual preferences. People’s religious preferences are supported with Ministers of different religions encouraged to visit and special requests are made on behalf of individual people. A Holy Communion Service is held once a month and services are arranged at Christmas. Visitors are welcome at any time and people are able to meet their visitors in the privacy of their own rooms. There is also a quieter lounge area that they can use if they wish. We spoke to relatives and they confirmed that they could visit whenever they wanted. People’s individual preferences about getting up or going to bed are respected. Care plans, particularly in the nursing unit, are being developed so that they reflect individual preferences. We spoke to people about the quality of the meals in the home and everyone was very complimentary. A resident told us “that there is always a choice and if there isn’t anything I like the cook will make something different”. Another person told us “the food is very good here”. The cook informed us that she had recently spent time with the people living in the home and amended the menus to reflect their preferences, and people we spoke to confirmed this. We observed mealtimes and saw that people were assisted in a sensitive manner. At our last visit we had concerns that peoples specific dietary needs were not always being recognised at mealtimes. At this visit we saw that records for this had improved and the cook confirmed that she was given regular updated information relating to any change in need for people. At this visit we also saw that people were assisted with their meals in accordance with their needs. Cooksditch House Nursing and Residential Home DS0000023399.V372359.R02.S.doc Version 5.2 Page 17 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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a complaints procedure in place, but not all people feel confident that their concerns are always acted upon. Adult protection procedures serve to safeguard the people living in the home. EVIDENCE: There is a written complaints procedure and this is made available to all people living in the home. It is also contained in the Statement of Purpose and displayed on the notice board. At our last visit we identified that where people had raised concerns they felt that these were not always being addressed. The feedback we received at this visit showed that people knew whom to speak to if they were not happy and knew how to complain. Relatives however stated that it was not always possible to find a senior member of staff to voice their concerns to. One person told us that they could leave a message and ‘someone would usually get back to them’. Another person told us that they had been unable to pass on their concerns to a member of staff and had not taken a particular matter any further. A Care Manager also advised us that it was not always possible to speak to the Manager or a senior member of staff. A relative also informed us Cooksditch House Nursing and Residential Home DS0000023399.V372359.R02.S.doc Version 5.2 Page 18 that where meetings were arranged so that people could voice their opinions, they felt that negative comments or concerns were not always acted upon. We were informed by the home that there had been 1 written complaint since our last visit and that this had been resolved. We (The Commission) have not received any complaints about the home. There is currently an ongoing safeguarding adults investigation underway, which is being carried out by Kent County Council. As part of this the home continues to receive input and support from the Local Authority and Primary Care Trust. Cooksditch House Nursing and Residential Home DS0000023399.V372359.R02.S.doc Version 5.2 Page 19 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, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst the majority of people benefit from living in a safe, clean and comfortable environment, there are areas of the home which need addressing. EVIDENCE: We toured the building and viewed communal areas and a selection of bedrooms. At the time of our visit the dining room in the residential unit was out of use, following water damage. Repair and re-decoration work was currently being carried out and we were informed that this would be completed by the end of September. As this dining room was out of use, people were either eating in their own rooms, in a small lounge area, which had been adapted for temporary use into a dining room, or using the dining area in the nursing unit. Cooksditch House Nursing and Residential Home DS0000023399.V372359.R02.S.doc Version 5.2 Page 20 We spoke to people living in the home and they confirmed that they were able to choose where they preferred to eat. Regulation 37 of the Care Homes Regulations (2001) states that we (The Commission) must be informed of any event that adversely affects the well being of people living in the home. We had not been informed of this and we identified this at the time of our visit. Some areas of the home, particularly in the main reception area had a strong odour – this needs addressing. The Annual Quality Assurance Assessment and the representative of the registered provider confirmed that there is an ongoing maintenance programme, which includes plans to replace carpets in order to address this. Individual rooms were seen to contain personal possessions such as photographs and ornaments. At this visit we saw that bedrooms were clean and tidy. We spoke to 3 people who all said that they were happy with their rooms. People are supplied with specialist beds where their needs indicate and in individual en-suites we saw raised toilet seats and grab rails. At our last visit we saw that there were issues relating to infection control procedures and a requirement was made to this effect. At the time of this visit we identified that the infection control procedures had now been addressed and the cleanliness had improved. There were mixed comments on the overall cleanliness of the home with returned surveys stating that that home did not always smell clean and fresh, but felt that steps were being taken to address this. Another comment was that bedding was not always changed when it was needed. There are systems in place to manage laundry in accordance with good practice. The sink and floor in the laundry need to be maintained to a cleaner standard. It is apparent that some refurbishment has taken place, but there are areas that still need attention and the home must continue with its maintenance and renewal programme. Cooksditch House Nursing and Residential Home DS0000023399.V372359.R02.S.doc Version 5.2 Page 21 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home can be confident that they are cared for by staff who have a good understanding of their needs. Recruitment procedures do not serve to adequately safeguard people living in the home. People are put at risk where temporary staff are not provided with an appropriate induction. EVIDENCE: We looked at the rotas for the staffing levels in the home. There are seniors on duty for each shift in the residential unit and they are supported by allocated staff. In the nursing unit a senior nurse is on duty who oversees a shift and is supported by a junior nurse and allocated care staff. At night there is a nurse on duty and three care staff. There are also allocated ancillary staff for cooking, cleaning and maintenance. Two relatives told us that they sometimes found it difficult to find a member of staff if they wanted to speak to someone about anything. Another relative informed us that she felt her Mother was left alone too much, and spent much Cooksditch House Nursing and Residential Home DS0000023399.V372359.R02.S.doc Version 5.2 Page 22 of her time in the lounge with no staff available. A resident living in the home said “sometimes I have to wait, but someone will always come if I ring for assistance”. The registered provider is recommended to consider how staff are deployed within the home. We looked at the recruitment records for three new members of staff. We saw that although there are procedures in place, some of the practices were not as robust as they should be in accordance with the Care Homes Regulations 2001. We identified that one application form had gaps in employment dates which had not been fully explored, another application form did not have the health declaration completed and the third file did not have a reference from the last employer – a requirement has been made with regards to recruitment procedures. We saw that where nurses are employed their ‘Pin’ numbers are checked and all staff are subject to both a Protection of Vulnerable Adults (POVA) and Criminal Records Bureau (CRB) check. We looked at the induction processes for new staff, care staff confirmed that they undertook an induction and records supported this. At our last visit we identified, however, that although an induction had been developed for nurses it had not been implemented. We saw at this visit that although two new nurses had started working at the home, the induction for nurses had still not been used. A requirement is being made that new nursing staff must undergo an appropriate induction. At the last visit we made a requirement with regards to the ongoing development of the training programme, as this visit we looked at training records. We saw some evidence that training needs continued to be addressed and that training programmes had taken place in relation to infection control, fire awareness, health and safety and protection of vulnerable adults. At the time of our visit the training matrix was not up to date and records were not readily available. We requested that the information was forwarded to us within 48 hours, and this was completed. The matrix showed that there are still some outstanding training needs, but the home is aware of these and they continue to access training for staff. Members of staff spoken to confirmed that they had completed different training courses including movement and handling. The Primary Care Trust have also been involved with the nursing unit in providing training and support for nurses in relation to person centred planning, assessments and specialist training such as providing flu injections. There is still a limited amount of specialised training taking place in relation to conditions such as dementia, although at the time of our visit it was confirmed that there are training courses planned in this. The registered provider must make sure that this is implemented in order to meet the individual needs of the people living in the home. Cooksditch House Nursing and Residential Home DS0000023399.V372359.R02.S.doc Version 5.2 Page 23 The home uses agency staff in both the residential and nursing unit, however as stated earlier in this report it has been identified that there have been errors made particularly in relation to medication. We looked at the induction / introduction process for agency staff working in the home and saw that it was not robust. There is no mechanism for fully making sure that the agency staff are competent to carry out the duties which are expected of them, and where there is an induction programme in place there was no evidence to show that this is always implemented. The Care Homes Regulations states that at all times there must be suitable, competent and experienced persons working at the home and the employment of any person on a temporary basis will not prevent service users from receiving continuity of care. A requirement is being made to this effect. People who live in the home and visiting relatives all spoke very highly of the staff working in the home. A resident told us “I can’t fault the staff here – they are wonderful” and another person told us “the staff are very good and are very caring”. Cooksditch House Nursing and Residential Home DS0000023399.V372359.R02.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, 35, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Lack of pro-active strategies has resulted in some practices that do not fully promote and safeguard the health, safety and welfare of the people using the service. EVIDENCE: The owner has appointed a person to run the home on a day to day basis in the position of manager. They are not registered with the Commission, but have been referred to as ‘the manager’ within this report. The manager oversees the home and is supported by a lead nurse in the nursing unit and a head of care in the residential unit. Evidence as reflected Cooksditch House Nursing and Residential Home DS0000023399.V372359.R02.S.doc Version 5.2 Page 25 throughout this report indicates that the home is being managed in a reactive manner. The Registered Provider needs to make sure that the home is proactively managed in order to comply with regulations and good practice. Regulation 37 of the Care Homes Regulations clearly states that we (The Commission) must be informed of any adverse events affecting the well being of people living in the home. We identified at this visit that this was not always happening and we had not been informed of key events that had a regulatory impact. A requirement has been made that we are now kept informed of events in accordance with Regulation 37. At our last visit we saw that the system for managing personal monies held on the behalf of service users had not been maintained to a standard that fully protected people. We reviewed the system at this visit and saw that this had been addressed and the system was now more robustly maintained with improved record keeping and supporting people with making sure that they had adequate personal finances available to them. Formal supervision for nurses is now taking place with the senior nurses receiving supervision from the manager and being supported by the PCT. They are cascading the supervision process to the junior nurses. There is limited formal supervision taking place for care staff. All care staff we spoke to said that they felt well supported by the manager and that there was always someone available to seek advice or speak to. This process does need to need formalized in accordance with the Care Home Regulations and National Minimum Standards for Older People. At our last visit in March we looked at maintenance records and these were not fully reviewed at this visit. On the day of our visit the home had arranged a fire drill and is currently updating their fire procedures. We saw that hoists had now been serviced and staff had received movement and handling training. Additional staff have also received training in First Aid. Records are maintained in the kitchen for monitoring food temperatures and fridge and freezer temperatures. Food was covered up and dated and stored appropriately in fridges. There is a schedule in place for cleaning the kitchen. Cooksditch House Nursing and Residential Home DS0000023399.V372359.R02.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 3 X 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X 2 X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 3 2 X 2 Cooksditch House Nursing and Residential Home DS0000023399.V372359.R02.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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) (2) (b) (c) Requirement Timescale for action 31/12/08 2 OP9 13 (2) 3 OP16 22 The Registered Person shall prepare a written plan as to how the service users needs in respect of health and welfare are to be met and the Registered Person shall keep the service users plan under review and revised. In that care plans are continued to be developed for all people living in the home and any changes are incorporated giving clear guidance to staff. 31/10/08 The Registered Person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. In that Only staff that are trained and assessed as competent in accordance with the homes policies to administer medication. Medication is stored is the same state as received from the pharmacy. The Registered Person must 31/10/08 DS0000023399.V372359.R02.S.doc Version 5.2 Cooksditch House Nursing and Residential Home Page 28 4 OP27 18 (1) (a) (b) 5 OP29 19 (1) (b) 6 OP30 18 (1) (a) (c) (i) make sure that any complaint is fully investigated and outcomes recorded. The registered person shall, 31/10/08 having regard to the size of the care home, the statement of purpose and the number and needs of service users— (a) Ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. (b) that the employment of any person on a temporary basis at the care home will not prevent service users from receiving continuity of care as is reasonable to meet their needs. In that where agency staff are employed the home must evidence that they are competent to carry out their duties to meet the needs of the people living in the home. The registered person shall not 31/10/08 employ a person to work at the care home unless he has obtained in respect of that person the information and documents specified in paragraphs 1 – 9 of Schedule 2. In that there Is a written reference in place relating to the persons last employment relating to work with vulnerable adults. Is a full employment history A statement by the person as to their mental and physical state. The registered person shall, 31/10/08 having regard to the size of the care home, the statement of purpose and the number and needs of service users— DS0000023399.V372359.R02.S.doc Version 5.2 Page 29 Cooksditch House Nursing and Residential Home 7 OP31 8 8 OP38 37 (a) Ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. In that all nurses employed in the home undergo a thorough induction programme appropriate to the work they are to perform. Any person who carried on or 31/12/08 manages an establishment or agency of any description without being registered under this part in respect of its (as an establishment or, as the case may be, agency of that description) shall be guilty of an offence. Care Standards Act 2000 (11 (1)) In that an application be made for a registered manager by date set. This requirement remains outstanding and had been extended until 31 December 2008. The Registered Person shall give 31/10/08 notice without delay to the Commission of any occurrence of death, illness and other events adversely affecting people living in the home. 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 OP3 Good Practice Recommendations That the admissions assessment process continues to be DS0000023399.V372359.R02.S.doc Version 5.2 Page 30 Cooksditch House Nursing and Residential Home 2 3 4 5 6. 7. 8. OP9 OP12 OP19 OP28 OP33 OP36 OP37 developed in particular that all details are recorded on those people moving into the residential unit. That where handwritten MAR sheets are implemented, then there are 2 signatures to confirm that the information on the MAR sheet is correct. That all people benefit from having the opportunity to take part in pastimes or activities that suits individual needs, preferences and choices. The registered provider continues with their improvement and development plan. Priority should be given to addressing any areas of odour within the home. That the training programme continues to be maintained. That the quality assurance and quality monitoring systems are developed. That the supervision programme is maintained. That the registered provider develops the policies and procedures. Cooksditch House Nursing and Residential Home DS0000023399.V372359.R02.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Cooksditch House Nursing and Residential Home DS0000023399.V372359.R02.S.doc Version 5.2 Page 32 - 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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