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Inspection on 18/05/06 for Cooksditch House Nursing and Residential Home

Also see our care home review for Cooksditch House Nursing and Residential Home for more information

This inspection was carried out on 18th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has created a warm and friendly atmosphere in which service users live. Service users spoken to praised the work staff do on their behalf and commented favourably about the quality of their surroundings. Prospective service users are encouraged to visit the home with their family prior to admission on a trial basis. During the course of their visit they are shown the room in which they will be living and are introduced to the staff and other residents. The home has an activities co-ordinator who develops a weekly programme of activities in and out side the home. Many of the service users spoken to said that they like to have the choice of things to do without feeling pressured to join in. The activities include events that are happening in the local community. The activities co-ordinator`s flexible approach means that she is happy to support service users at the weekend when such events are likely to be held.

What has improved since the last inspection?

The home has invested in a new fridge since the last inspection, and the refurbishment programme continues.

What the care home could do better:

Service users need to be more involved in the formulation of their care plans. Plans of care need to reflect current assessments of the service users` needs and this process needs to be revisited at least monthly with all relevant staff reviewing and updating the plans and setting appropriate goals. Whilst some of the staff were indeed reviewing the care plans and recording the outcomes, it was noted that some plans had not been changed when the needs of the service user had changed. The home does record weight for all service users and blood sugar levels for the diabetic service users on a regular basis. However, when there has a problem with the levels no follow up action was recorded. The manager has agreed to monitor the medication systems in the home regularly in light of some discrepancies found on the nursing side of the home. The home does serve home made meals cooked using fresh ingredients though the current menu does not offer real alternatives for service users to choose from and the manager is working with the cooks to facilitate this. The home does facilitate staff training and a number have undertaken the required courses. However, it was apparent that not all staff have as yet completed all the required training and the home still needs more staff to achieve the NVQ Level2 or above to reach the 50% target. Whilst the home does hold regular meetings with staff, service users and families it has yet to formulate an effective quality assurance policy and procedures which includes sending out questionnaires to monitor the progress of care provision within the home.

CARE HOMES FOR OLDER PEOPLE Cooksditch House Nursing and Residential Home East Street Faversham Kent ME13 8AN Lead Inspector Sally Hall Unannounced Inspection 18th May 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 House Nursing and Residential Home DS0000023399.V296220.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. Cooksditch House Nursing and Residential Home DS0000023399.V296220.R01.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 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.V296220.R01.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. LD(E) is restricted to one (1) person with a date of birth of 07/09/1938 17th January 2006 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. The fee range for residential is £316.77-£440.00 and £420.41-£528 for nursing excluding the RNCC. (the nursing element) Cooksditch House Nursing and Residential Home DS0000023399.V296220.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key Inspection at Cooksditch House Residential and Nursing Home took place on the 18th and 19th May 2006 between 10am and 4pm. Whilst on site the Inspector agreed and explained the inspection process with the senior staff on duty and the Manager. Time was spent reading a sample of care plans, written policies and procedures and records kept within the home. Service Users and staff were spoken with and a tour of premises was undertaken. The manager was asked to complete a pre-inspection questionnaire and to give out survey forms to service users, relatives/friends and health professionals who have an input into the home. The information from these and that gathered since the last inspection was used in the report where appropriate. The focus of the inspection was to assess Cooksditch House Residential and Nursing Home in accordance with the National Minimum Standards for Older People. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. What the service does well: What has improved since the last inspection? The home has invested in a new fridge since the last inspection, and the refurbishment programme continues. Cooksditch House Nursing and Residential Home DS0000023399.V296220.R01.S.doc Version 5.2 Page 6 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. Cooksditch House Nursing and Residential Home DS0000023399.V296220.R01.S.doc Version 5.2 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 House Nursing and Residential Home DS0000023399.V296220.R01.S.doc Version 5.2 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): 1-5 Quality in this outcome area is good Service users are given information to help them make an informed choice about the home. Prospective service users benefit from having a good pre-admission assessment before they are offered a place at the home. All service users and heir families can be confident that they will be encouraged to visit the home during their trial stay period and beyond if placed at the home on a full-time basis. EVIDENCE: The Statement of Purpose and Service Users Guide had been reviewed. It contains information to help the enquirer to make an informed decision about moving in to the home. On the service users files sampled, contracts/terms and conditions were seen. The manager was advised that regardless of who was responsible for paying the fee this amount should be stated in the document. Cooksditch House Nursing and Residential Home DS0000023399.V296220.R01.S.doc Version 5.2 Page 9 The pre-assessment document was seen on the files sampled. The manager explained that she or the head of care would normally either visit a prospective service user in their own home or in hospital. She explained that she would try to ensure that she talked to people who had previously been caring for the service user. Information taken about the service user and their medical history was recorded and used to ascertain if the home was be able to meet their needs. The manager said that if the referral came via the local authority then she would receive an assessment and care plan from the placing care manager. As the home is divided and caters for both residential and nursing needs of the service users, it does have a large number of care staff, some of who work along side the nurses in the nursing unit. Few care staff at the home currently have gained an NVQ Level 2 in Care but the manager stated that there were seven staff currently undertaking this training. The staff training record was seen but it was not possible to evidence that all staff had undertaken all the required statutory training. The nurses do have the opportunity to undertake training courses to ensure there registration remains current. Some specialist courses for both nurses and care staff were evidenced to cater for service users’ specific needs. The inspector found from talking with staff and residents in the home that prospective service users were encouraged to visit the home and spend time there prior to staying for a trial period. The head of care explained that this time was also used to assess how well the prospective resident got on with the other residents already living at the home. At the end of the trial period a review was then held with all the interested parties. If the trial period had gone well the resident was offered a permanent place. Cooksditch House Nursing and Residential Home DS0000023399.V296220.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7-10 Quality in this outcome area is Poor Service users cannot be confident that their care plans are updated regularly to reflect their current care and nursing needs. All service users cannot be confident that their health is being monitored effectively and appropriate action taken when required. The service users cannot feel fully confident that they are protected by home’s procedures with regard to the administration and recording of medication. Service users can be confident that they will be treated with dignity and respect by the staff of the home. EVIDENCE: The care plans seen on the service users files sampled covered a wide range of individual needs. Many were detailed and informative as to the staff intervention required to assist individual service users. However, it was evidenced that the care plans were not being updated regularly and Cooksditch House Nursing and Residential Home DS0000023399.V296220.R01.S.doc Version 5.2 Page 11 consequently some plans were out of date and did not indicate the current care needs of some service users. Records were seen which indicated that tissue viability, and mobility were regularly monitored. The staff weigh the service users monthly and evidence was seen that food intake is monitored. It was not apparent that the service users were involved in their care planning processes. The home does ensure that service users have access to doctors and other health professionals. Evidence was seen that opticians, dentists and chiropodists visit the home on a regular basis. As the home is registered for nursing care as well as residential care there is always a nurse on duty. The home is able to cater for different conditions and evidence was seen that staff are given specific training to meet particular needs. The home does have a number of diabetic service users. The staff are trained to take regular blood sugar readings but was concerning that high blood sugar results were not passed on or followed up. In one case examined by the inspector high blood sugar could have been the reason why one service user became agitated and acted out of character from time to time but no one had explored this possibility. Also of concern was that some staff spoken to do not understand what diabetic service users should be encouraged to eat or not eat. It appeared that at lunch all service users ate the same first course but that the pudding would be different. On the first day of inspection quiche, potatoes and salad was served for lunch followed by rice pudding, which contained sweetener rather than sugar for all service users. These issues were discussed with the manager who explained that the menus were currently under review with more choice and recognition of special diets being made. Risk assessments should be completed for any perceived risk to the service user or others in the home. It was evident that staff had identified risks on an individual basis for some service users but no individual risk assessment was found on the file. The home has a main medication room for the storage of medicines. It also has two trolleys which are used to transport the medication to service users. One trolley is kept in a lock room on the first floor for the nursing staff to issue from. The home keeps the medication totally separate between that used for nursing and residential service users. Care staff issue medication to the residential service users in the home and the head of care confirmed that those staff who give out the medication have had appropriate training. Nurses are responsible for the service users assessed as having nursing needs . It was for this reason the medication storage, recording and administration was looked at separately. On the residential care side the medication was found to be stored correctly and an audit showed that the medication was given out as prescribed. A recommendation was given to ensure that if service users did not have a known allergy that this was recorded on the Medication Record Sheet. Staff were also asked to ensure that any medication remaining at the end of the Cooksditch House Nursing and Residential Home DS0000023399.V296220.R01.S.doc Version 5.2 Page 12 month/sheet is transferred to the new Medication Record Sheet so a true record is kept of what medication is kept in the building. On the nursing side a nurse went through the medication records and an audit was undertaken. The medication was sampled for a number of service users and it was found that medication had been signed for but not given. The records did not show any medication brought forward from the month before and did not always indicate medication that had been brought into the home. These concerns were raised with the manager who was asked to investigate and monitor medication administration on a regular basis. The controlled medication records were found to be correct. The home has a medication fridge and the temperature is recorded daily. The home has a medication policy and procedure in place. Staff were reminded that PRN medication (medication given only when required) is recorded daily so that it is clear as to the dosages that had been given, to who and for what reason. Staff on duty were observed indirectly throughout the inspection. They were seen to interact in a positive and respectful manner with service users. Service users gave positive feedback during the inspection about the approach of the staff team, comments included “nothing is too much trouble for the staff” and “they are lovely”. Cooksditch House Nursing and Residential Home DS0000023399.V296220.R01.S.doc Version 5.2 Page 13 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): 12-15 Quality in this outcome area is adequate Service users benefit from a programme of activities within the home and have the opportunity to be involved in events happening in the local community. Service users do not have the benefit of a varied and balanced diet. Service users are encouraged to make choices to stay in control of their lives for as long as possible. EVIDENCE: The manager described activities planned take place throughout the course of a week. Staff are encouraged to help with activities and one to one time if they are not too busy. The plan for the week was reviewed in the absence of the activities co-ordinator since she was not available to comment at time of inspection. It was explained to the inspector that the activities co-ordinator was not on duty because she was planning due to her making herself available to support service users on an activity over the next weekend. The record of the activities and who have input was not available to check so it was not possible to see if all service users are involved in some motivational activity or whether there are one to one or a group activities throughout the week. The staff do not record any details about activities in the daily log. The home does have entertainers coming into the home and is part of the PAT dog scheme. As Cooksditch House Nursing and Residential Home DS0000023399.V296220.R01.S.doc Version 5.2 Page 14 many of the service user find it difficult to go out shopping the home arranges for a clothing show to be held at the home from time to time. There is a lot of emphasis on being part of the local community and accessing local events. Service users said they enjoyed the activities offered to them. On the day of the inspection, service users were observed watching the television, listening to music and reading newspapers and magazines. The manager confirmed a religious service was held in the home once a month. Service users informed the inspector that they were free to choose how they spend their day; this included what time they rose and went to bed. One service user stated “There was usually something going on during the week if you want to take part”. Another service users said that when she felt well enough she liked to join in, although she did not feel able to go on outings. The results of Commission for Social Care Inspection survey reflected the findings above. The staff also said that some families take their relative out. Families spoken to said that they are made to feel welcome when they visit; that they are kept well informed of what is happening in the home and about the health of their relative. The inspector joined service users for lunch on the second day. Service users said that the meals were OK but they confirmed that they do not get a choice at midday unless they don’t like what is offered then they can have an omelette. Service users explained that they do get offered a drink at lunchtime, water or squash; they requested that the squash be made stronger. They also requested that they be asked what they wanted to eat since they sometimes did not like things on their plates that they didn’t like. The meal served on the day of the inspection was fish in breadcrumbs, chips and peas. Several service users said they didn’t like peas. The meals come to the dinning room ready plated. On this occasion the fish was dry though the meal was hot. Meals are delivered to the dining areas in hot trolleys; the meals were plated in the kitchen which is why the service users are not able to choose what is on their plates. During the tour of the building it was also noted that meals are plated at 11:30am and are not served until 12:30pm. This practice could be why the meal served that day was, in part, dry. The manager and cook were asked to review this practice. The staff had to be asked for salt, ketchup and tartar sauce since these were not available on the table. Service users spoken to were of the view that the meals offered at the home were generally acceptable but that some days were better then others. The manager is aware of the poor choice and has started work on new menus, which will offer a balanced diet, with plenty of choice and will cater for special diets. Service users are also going to be asked to have input to these new menus. The cook said that the home uses a lot of fresh produce and most of the meals are home made. The meals served during the day are very close together with the consequence that the time between the evening meal and breakfast exceeds twelve hours. A snack and a drink is provided by the home Cooksditch House Nursing and Residential Home DS0000023399.V296220.R01.S.doc Version 5.2 Page 15 at 7.30pm each evening though this may not be convenient for all residents. The head of care and manager were asked to review the times meals are served. The survey by the Commission for Social Care Inspection found that whilst some service users indicated that they liked the meals, others said they only sometimes enjoyed them and some commented about the lack of choice. Cooksditch House Nursing and Residential Home DS0000023399.V296220.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is adequate. Service users and their relatives and friends can be confident that their complaints will be listened to and acted upon. Service users cannot be confident that they are protected from harm because the home’s policy and procedures with regard to Adult Protection is not satisfactory and staff do not receive sufficient training in this area. EVIDENCE: The complaints policy had been reviewed and it did contain timescales for action. The responses made in the home’s pre-inspection questionnaire confirmed that the policy was available in different formats. The head of care and manager stated that they had not dealt with any complaints during the last year. However, several complaints had been received by CSCI and/or Social Services about the home. For example a complaint had been received that there was no hot water in some of the service users rooms. When this was discussed with the manager she indicated that the home had been aware of the problem and that the boiler had been replaced. Discussion with service users indicated that some complaints that are made are not recorded as staff don’t recognise them as such and deal with them in a very short time span or straight away. Cooksditch House Nursing and Residential Home DS0000023399.V296220.R01.S.doc Version 5.2 Page 17 In the service users survey by the Commission for Social Care Inspection some service users said that they were unsure of how to complain. However service users spoken to though the inspection said that they knew who to speak to if they were not happy about the service they received and felt able to talk to the staff should the need arise. The home has retained many of the compliments sent in by relatives of past service users. These praised the staff for there kindness and commended the level of care they received while at the home. The home’s Adult Protection policy and procedure seen did not cover the changes in legislation regarding POVA List (Protection of Vulnerable Adults) etc. The manager was asked to review this procedure to reflect the recent changes. The home has not received the new Adult Protection protocols from the local authority. The manager was asked to obtain a copy of this as soon as possible so as to ensure that the staff of the home staff will know what actions to take following an incident or disclosure which may have Adult Protection connotations. The training records seen confirmed that most staff have still not undertaken adult protection training, although the manager said that the training is now part of the induction programme and the matrix may not be reflecting a true picture. The manager said that she has 4 staff booked for this course in May 2006. The manager has been asked to ensure that all staff needing this training do so as quickly as possible. Cooksditch House Nursing and Residential Home DS0000023399.V296220.R01.S.doc Version 5.2 Page 18 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): 19-26 Quality in this outcome area is good The service users benefit from living in a clean and homely environment which equipped to meet their needs. However service users’ safety is compromised owing to a lack of an effective call alarm system and problems with the fire alarm system. EVIDENCE: A full tour of the building was undertaken with the head of care. Starting with a sample of the service users rooms with their permission, it was noted that these rooms generally were in good decorative order and the service users had personalised the room to their own taste. The home has mainly single rooms with just five shared rooms; many of the rooms also offer an en-suite facility. In the shared rooms to give privacy there are dividing curtains. The head of care confirmed that service users in shared rooms are offered a single room when becomes available. Cooksditch House Nursing and Residential Home DS0000023399.V296220.R01.S.doc Version 5.2 Page 19 During the tour of the building the call alarm system was tested. The poor staff response time was of concern, and when staff did try to answer the call they went to the wrong bedroom. There appeared to be a fault with the system which was quite old. Staff hearing the alarms have to go a board on the ground floor to identify where they are needed. The staff do not have pagers which would give this information immediately where ever they are. This would reduce the time taken to respond. The manager said that they were in the process of collecting estimates for a new system which might include the use of pagers. The bathrooms and toilets seen were clean but very clinical and not inviting or relaxing. While it is recognised it is import to be able to keep this area clean it is possible to inject some warmth and colour to the area without compromising infection control. This was discussed with the head of care. The home generally is well maintained with areas identified as in need of renovation on a rolling programme of works. The home is large but is managing to retain a fairly homely feel with wall hangings and the use of colours throughout. There are three lounges and two dining areas, which service users can choose to use. There is also a conservatory area, which was used by different service users throughout the day. There is a quiet lounge, activity room and a visitor’s area also available for service users use. The inspector was informed that the dishwasher had been out of use for 9 weeks. However the manager had allotted extra staff hours to cope with the extra washing up during this time. During the visit to the home the fire alarms were triggered twice. This indicated two sets of problems: firstly one of the main entrances/exits to the home could not be used from the outside as it is on a system whereby staff have to open the door. The manager was asked to look in this since firemen may need to use this entrance in an emergency. Secondly, when the alarms were triggered they could only be heard in some parts of the building but not in others. This was witnessed by the inspector. Cooksditch House Nursing and Residential Home DS0000023399.V296220.R01.S.doc Version 5.2 Page 20 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): 27=30 Quality in this outcome area is poor Service users are potentially put at risk because of inadequacies in the home’s recruitment procedures. The care of service users is compromised because the home does not have sufficient staff on duty at all times that are fully trained. EVIDENCE: The staff files were sampled and generally they held the information required. However it was noted that a number of staff CRB checks had not been undertaken by Cooksditch and that CRB checks had been accepted from other places of employment. The inspector informed the manager that this practice had ceased in October 2004. The manager has been asked to check all staff records and obtain CRB checks for those staff who so far have not got a current CRB. It was noted that not all the references on file were from the previous home worked at. Rather, the reference requests appeared to have been asked from what would have been past colleagues. The manager was asked to ensure that references are requested in the first instance from the manager /organisation that employed the person. The home employs 30 care staff of these 8 have an NVQ level2 or above, and the manager confirmed that 7 are now on the course. The home should have at least 50 of it’s staff with an NVQ Level 2 or above by now and is falling Cooksditch House Nursing and Residential Home DS0000023399.V296220.R01.S.doc Version 5.2 Page 21 short of this target. However, if all the staff successfully complete their courses then the home will meet this minimum requirement. Evidence was seen that courses are being made available for the nurses to stay up to date, and specialist training is available to both care and nursing staff to meet service users’ individual needs. The training matrix did show that there is a number of staff that have not completed the statutory required training and this needs to be addressed. The home’s figures for staffing hours are sufficient when checked against The Residential Care Forums guidelines, which are determined, by the dependency and sometimes structure of the building. The results of the survey sent out by the Commission for Social Care Inspection indicated that a number of people who responded to the survey felt the staffing levels should be higher. It is important that the home is fully staffed at all times to meet the individual needs of the service users. It was confirmed that staffing hours are adjusted according to the dependency level of the individual service users in the home and the occupancy levels. The manager confirmed that the home does use agency staff as a back up to their own when cover cannot be found in-house. Cooksditch House Nursing and Residential Home DS0000023399.V296220.R01.S.doc Version 5.2 Page 22 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, 32, 33, 36, 38 Quality in this outcome area is adequate. The service users benefit from having a manager running the home who is appropriately qualified and has a good breadth of experience in managing homes. The leadership in the home is open and positive with good lines of communication throughout. Staff competencies are compromised because they do not sufficient regular supervision or training Service users’ rights are safeguarded. The health and safety of service users and staff is compromised by the lack of regular maintenance testing and lack of staff training in this area. Cooksditch House Nursing and Residential Home DS0000023399.V296220.R01.S.doc Version 5.2 Page 23 EVIDENCE: The manager has applied to become the registered manager and that process should soon be completed. The manager has a wealth of experience in the care profession and is 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. The manager has completed dementia training facilitated by the Alzheimer’s society. She is currently in the 2nd year of a social care and welfare degree. The manager has also been the registered manager of a residential nursing home prior to taking up her post at Cooksditch House. It was evident that the manager is approachable and communicated well with staff, service users and visitors to the home. The manager has been post since 31st May 2005 and is gradually up-dating and introducing systems of work to ensure the needs of the service users are met and that the home meets it statutory obligations under the Care Standards Act. The manager still has much to do but in talking to her it was evident that she has identified what needs to be done. There was evidence of staff supervision in the staff files sampled but as yet the target of formal supervision six times per year has not been met. The quality of the supervision record is very good and covered the required topics. Staff are also asked for their input prior to the diarised meeting so good use is made of the time allotted. The home has not yet formalised a quality assurance system. The home is planning to send out its own customer survey to service users, friends/family and health professionals who visit the home on a regular basis. The home plans to feedback the findings to the service users and others at least on a yearly basis. The home does have regular staff meetings and the home does produce a newsletter monthly, which informs service users and families of futures events etc. A residents meeting is also held monthly. The home has secure storage for all confidential information. Staff spoken to were aware of who had a right to see service users’ files for example. The manager completed a pre inspection questionnaire; it stated that the home’s maintenance certificates are all in date and regular tests are taking place. The only certificate date not given was for the electrical wiring certificate for which it was noted that they were awaiting a visit. The home needs to arrange this visit as soon as possible if the certificate has expired and inform the Commission once the new certificate has been issued. The lift engineer last visited the home on the 01/08/05. The home needs to check this as, with all lifting equipment, it needs to be checked and given a LOLER certificate six monthly. Other lifting equipment had been seen in the previous six months. Cooksditch House Nursing and Residential Home DS0000023399.V296220.R01.S.doc Version 5.2 Page 24 The home has most of the required policies and procedures in place and these have recently been reviewed. The manager has been asked to look at the Adult Protection policy and procedure in light of recent changes to legislation etc. The manager was asked for a copy of the home’s annual development plan/business plan for the home but this was unavailable. The policies and procedures are accessible to all staff. The home has an up to date file on COSHH and staff knew where to locate this and how to use it to find the first aid required in an emergency. The manager confirmed that regular tests are done on the fire alarm and emergency lighting systems; the problems experienced during the two false alarms were discussed with the manager. The manager confirmed that the required risk assessments are in place for the building and fire procedures. Staff training needs to be kept current and as previously stated not all the statutory training for staff is up to date. The training expected for all staff is health and safety, infection control, moving and handling, first aid, adult protection, and fire training. Cooksditch House Nursing and Residential Home DS0000023399.V296220.R01.S.doc Version 5.2 Page 25 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 X 18 2 3 3 3 2 3 3 3 3 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 3 3 2 X X 2 3 2 Cooksditch House Nursing and Residential Home DS0000023399.V296220.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation Requirement Timescale for action 31/08/06 2 OP8 3 OP9 12, 18, 23 A service user plan of care generated from a comprehensive assessment (see Standard 3) is drawn up with each service user and provides the basis for the care to be delivered. With regular monthly reviews by staff and new assessments and care plan six monthly, more often if change in condition. 13, 14, 16 The registered person promotes and maintains service users’ health and ensures access to health care services to meet assessed needs, ensuring that any problems are documented and followed through with the outcomes being recorded. 13,17, The registered person ensures that there is a policy and staff adhere to the procedures for the receipt, recording, storage, handling administration and disposal of medicines, and service users are able to take responsibility for their own medication if they wish, within a risk management framework. Monitoring on a regular basis to ensure compliance. DS0000023399.V296220.R01.S.doc 30/06/06 30/06/06 Cooksditch House Nursing and Residential Home Version 5.2 Page 27 4 OP15 16 5 OP18 6 OP22 7 OP27 8 OP28 9 OP29 10 OP33 The registered person ensures that service users receive a varied, appealing, wholesome and nutritious diet, which is suited to individual, assessed and recorded requirements, and that meals are taken in a congenial setting and at flexible times. 12, 13 The registered person ensures that service users are safeguarded from any type of abuse, in accordance with up dated written policies and by ensuring staff receive adequate training. Schedule Call systems with an accessible 23 (2)(n) alarm facility must be provided in every room that the service users use regularly. 17, 18, 19 Staffing numbers and skill mix of qualified/unqualified staff are appropriate to the assessed need of the service users, the size, the layout and purpose of the home, at all times. Number of staff /hours in respect of service user needs based on guidance recommended by Department of Health. 18 A minimum ratio of 50 trained members of care staff (NVQ Level 2 or equivalent) is achieved by 2005, excluding the registered manager and/or care manager, and in care homes providing nursing, excluding those members of the care staff who are registered nurses. 19 The registered person operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. All staff must have a CRB check carried out by the home. 24 Effective quality assurance and quality monitoring systems, DS0000023399.V296220.R01.S.doc 30/07/08 30/10/06 30/10/06 30/07/06 31/03/07 30/06/06 30/11/06 Page 28 Cooksditch House Nursing and Residential Home Version 5.2 11 OP36 18,19 12 OP38 12, 13, 23, 37 based on seeking the views of service users, are in place to measure success in meeting the aims, objectives and the statement of purpose of the home. The registered person ensures 30/07/06 that the employment policies and procedures adopted by the home and its induction, training and supervision arrangements are put into practice and are ongoing to the required level. The registered manager ensures 30/07/06 so far as is reasonably practicable the health, safety and welfare of service users and staff. 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. Refer to Standard OP16 OP19 OP30 Good Practice Recommendations Ensure that service users/families know how to complain and staff have a good understanding of the complaints procedure, helping staff to recognise what is a complaint. Please ensure that the dishwasher is back in service as soon as possible, or replace if the parts are not available Ensure that staff complete all the statuary training required that is not covered in the induction and for those older staff that may not have done the induction. Cooksditch House Nursing and Residential Home DS0000023399.V296220.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cooksditch House Nursing and Residential Home DS0000023399.V296220.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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