Inspection on 27/09/07 for Cooksditch House Nursing and Residential Home

This inspection was carried out on 27th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 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... 17/09/08

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

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Cooksditch House Nursing and Residential Home East Street Faversham Kent ME13 8AN Lead Inspector Sally Hall Key Unannounced Inspection 27th September 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cooksditch House Nursing and Residential Home DS0000023399.V344992.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.V344992.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 Tina Anne Cloke 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.V344992.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 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 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 £326.33-£488.00 and £445.28-£583 for nursing excluding the RNCC. (The nursing element) Cooksditch House Nursing and Residential Home DS0000023399.V344992.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 Nursing and Residential Home took place on the 27th September 2007 starting at 09.30 hours. The lead inspector was Sally Hall and regulation inspector Sue McGrath and pharmacy inspector Jeanette Datoo accompanied her. The intention of the inspection was to evidence any improvements made in the intervening months since the last key inspection and to undertake a random pharmacy inspection of the home. On the day of the inspection the inspectors agreed and explained the inspection process with the registered manager. Time was spent reading a sample of care plans, written policies and procedures and records kept within the home. Staff were spoken with and a tour of premises was undertaken. The focus of the inspection was to assess Cooksditch House Nursing and Residential Home in accordance with the National Minimum Standards for Older People, primarily concentrating on the areas of concern from the most recent inspections. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. The Commission has received information and concerns from various sources about the quality of care at the home. Unfortunately there was insufficient time prior to the inspection to send out surveys to service users, their families and other health professionals. However, it was possible to speak to relatives during the inspection process and their views are included in this report. What the service does well: What has improved since the last inspection? Cooksditch House Nursing and Residential Home DS0000023399.V344992.R01.S.doc Version 5.2 Page 6 Recruitment procedures have improved with all new staff now having a CRB (Criminal Record Bureau) check. This was not the case at the previous inspection. An induction programme has recently been implemented. There has been some improvement in the recording and administration of medication. What they could do better: A comprehensive pre assessment is undertaken for all new service users. However, there was concern raised about two service users who have possibly been admitted with needs that are not covered by the home’s current training programme. Such identified needs include service users suffering with dementia, strokes and Parkinson’s disease. It was also noted that staff at the home have not received all the mandatory training. The individual service users’ care plans were seen for both residential and nursing service users. Generally these were well written though they did not cover all the needs of the service users and there was no evidence of involvement of the service users or their family in the formation of these plans. Whist the assessment process was generally comprehensive areas of care needs and high risks have not always been followed up or documented in the care plans. The daily record did not cross reference well with the care plans as they lacked detail of the care provision. Some aspects of health were documented but not always followed up, for example, with the registered manager or the GP. The times in the daily records showed the time that the entries were written rather than when care provision was given or events actually occurred. This was brought to the attention of the registered manager during the last inspection. Since the last inspection of medication there have been some improvements. However, some requirements still remain outstanding and service users cannot be confident that they will always get the medication they are prescribed. Meals provided at the home are good. However, it is important that equipment used for serving meals and serving meals from are kept clean. Staff should ensure that service users get the support they need at mealtimes.. The registered manager must make sure that if abuse is reported within the home that she follows the correct procedure. The inspection evidenced that standard of cleaning was low, with floors, paintwork and surfaces generally in need of dusting or a thorough clean. There was an offensive smell of stale urine in areas and bedrooms within the home. There was a lack of lampshades in toilets and bathrooms and generally the Cooksditch House Nursing and Residential Home DS0000023399.V344992.R01.S.doc Version 5.2 Page 7 bathrooms were not inviting places. The kitchen was covered in a film and grease and would benefit from a major professional clean. Other areas were highlighted in the kitchen such as wholes in the fly screens and flies trapped in the light diffusers above the work surfaces. The inspection highlighted Health and Safety issues. Examples include such as a ramp that is slippery when wet and carpets that have come away from the rods which could be a trip hazard. The décor within the home is, in some areas, in need of redecoration. Not all staff at the home have had the required training and not enough staff have attained the NVQ level 2 in Care. The rota seen indicated that one domestic staff is on duty at the weekends and when domestic staff are on annual or sick leave their duties are not covered. Suitable arrangements need to be in place to cover the manager’s responsibilities in her absence for annual leave etc. 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.V344992.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cooksditch House Nursing and Residential Home DS0000023399.V344992.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4, 6. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users cannot be fully confident that if they are offered a permanent placement at the home then staff will be able to meet their individual needs. Some service users with particular needs may be put at risk because of a lack of staff training with regard to the proper management and care of those needs. EVIDENCE: Examples of pre-inspection assessments were seen in the files of both newly admitted service users to the home and those who had been resident for some years. The assessments seen had been completed fully and covered a wide range of information as required in Standard 3. The home also receives assessments from care managers when social services are supporting admissions to the home. The assessments are used to determine if the home can meet the service users needs prior to them being offered a trial stay at the Cooksditch House Nursing and Residential Home DS0000023399.V344992.R01.S.doc Version 5.2 Page 10 home. While sampling the files of the most recently admitted service users concern was raised regarding two service users who had been admitted to the home during the past three months who possibly were showing signs of dementia or mental health problems. Neither of these categories are part of the home’s current registration. Although a doctor had not confirmed the diagnoses there was sufficient evidence in the pre assessment for the manager to question the appropriateness of their admissions. More evidence could be seen during the trial period. However, there was no evidence found that the home has followed this through with the care managers or the service users’ GP’s. Not all the staff at the home have undertaken the required training and many have not undertaken the more specialised training relating to the management of conditions such as diabetes, stroke, and Parkinson’s disease to make sure they have a good understanding of the pro0per care of service users with these particular needs. The home does not offer intermediate care. Cooksditch House Nursing and Residential Home DS0000023399.V344992.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care of service users is compromised in that whilst their care plans are well written they do not necessarily include all of their the needs.. Service users cannot feel confident that their health care needs will be followed up. Service user cannot be confident that they will always receive the medication prescribed for them. EVIDENCE: The individual service users’ care plans seen were generally well written and indicated to staff the actions they needed to follow to provide care to individual service users. However, it was noted on several files that areas of care or risk identified during the assessment process had not been documented on the plans. Whilst these assessments also identified the level of risk for various Cooksditch House Nursing and Residential Home DS0000023399.V344992.R01.S.doc Version 5.2 Page 12 needs, i.e. nutrition, pressure sores, and mobility, often there was no indication of any risk management strategies. This was highlighted in the last report. Outcomes recorded each month for individual items on the care plans were not evident on the files of the newer service users. These reviews record whether the actions of the staff are meeting the service users needs or whether changes are needed. This contrasts negatively with the previous inspection report which indicated these were seen to be well documented. During the last visit the daily record lacked detail and for many service users who actually require high staff input little was recorded. This has not changed. Observations and events were not followed up and it was evident that in some cases the registered manager had not been informed about important information pertaining to service users. Examples included a service user who was identified on admission as needing a chiropodist but two months later had still not seen one even though there is a chiropodist in the home on a weekly basis. Another example was seen of a man with skin tears to both arms; there was no dressing pathway, no accident report and a query of self harm had not been brought to the attention of the manager or the service user’s GP. It was noted that the times shown on the daily records still record the time that staff recorded the information rather than when things actually took place. Again this was identified in the last report. Staff were observed drag-lifting one service user out of his armchair to stand. A senior staff member stood in front of him and put his foot on the zimmer frame and lent over the frame and put his arm under the service user. Another member of staff tried to get to the side but was too close to the door. Both dragged him up. He stood up and was then put in a wheelchair. This is poor practice and it is important that staff practice is monitored and all staff receive manual handling training yearly. A relative spoken to said she was very concerned that her mother, who had leg ulcers (now nearly healed), had not been given a bath for some time owing to the dressings on her legs. Whilst her mother was always given a good body wash daily, the relative was concerned that her mother’s hair had not been washed regularly. The relative stated that the only time her mother’s hair was washed is when she sees her own hairdresser about every 6 weeks for a cut. The temperature of the medicines fridge was 100C, with a range of 7 to 140C. The manager said that a new fridge had been purchased but was not yet in use. The medication policy had been updated but still referred to the current system of disposal of medicines. There is an outstanding requirement for all unwanted medicines to be collected by a licensed waste disposal contractor. Staff were using a system of recording carried forward stock onto new medication charts. Records of administration and stock indicated that residents on variable dose anticoagulants were receiving the correct doses. Cooksditch House Nursing and Residential Home DS0000023399.V344992.R01.S.doc Version 5.2 Page 13 Non-soluble tablets had been prescribed for a resident with swallowing difficulties. The manager agreed to ensure this was reviewed. For one medicine, with a dose of two tablets, staff had recorded receiving 164 tablets and giving 70, but there were 97 remaining. This suggested that three doses had been only one tablet. Staff had faxed, on 25/09/07, to GP’s a request to prescribe thirteen medicines that were not received with the recent four-weekly delivery of medicines. This list included three medicines for two medicines for which there was no record of receipt and no supply found but administration had been recorded on 26/09/07. It was discussed with the manager that systems must be in place to ensure the continuing supply of medicines needed for continuing treatment. A number of service users were spoken with during the day, as were relatives visiting the home. Service users said that most of the staff were nice to them. During the day the inspector witnessed some very good rapport between staff and service users. However, on two occasions staff were seen attending to service users without closing their bedroom doors. When asked about if they felt they were treated with respect by the staff one service users said, “The care is very changeable at times. Staff do not seem to last long and they use a lot of agency staff”. Another said that “It’s very nice if you behave yourself if not you have to go somewhere else’”. Others were complimentary and said the staff were very nice. Another said the staff were OK and one service user said that “Most of the staff are very helpful nothing is too much trouble but it depends who it is”. However, one service user spoken to had her initials written on the front of her slippers and her handbag. This was felt to be inappropriate and compromising the service user’s dignity. When speaking to families and service users it was noted that there is a problem with the distribution of clothing once laundered. Service users complained that they had other people’s clothes in their room and on occasions service users had been found by their relatives not to be wearing their own clothing. The manager confirmed when asked, that she was aware of the problem which she said had been raised at a recent staff meeting. Cooksditch House Nursing and Residential Home DS0000023399.V344992.R01.S.doc Version 5.2 Page 14 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): 12,13,15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can be confident that there are activities and outings arranged at the home that they might join in with if they wish. Service users benefit from receiving meals that are nutritious and varied. EVIDENCE: During an interview with the activity co-ordinator she explained the various activities that she undertakes with service users in the home. There had been an outing the night before and although some service users complained they had been a little cold they had nonetheless enjoyed themselves. She showed a good understanding of the differing needs of the service users cared for at the home given that there are service users with nursing needs, those who are more able and some service users with dementia. The coordinator was pleased that her hours had now been increased to 30 per week as she felt that this would allow her more time with those who are confined to their bedrooms. A programme of organised activities was displayed in the corridor, and time was set aside for one to one sessions with those less able or who do not like doing things in groups. Outings are also arranged, mainly locally, and every effort is Cooksditch House Nursing and Residential Home DS0000023399.V344992.R01.S.doc Version 5.2 Page 15 made to ensure service users are kept in touch with the events happening locally. During the last inspection a favourite with some service users was the outing to the local café for a full English breakfast. This had not happened as often but the coordinator explained that more service users now wanted to go shopping locally. The way the activities are recorded had become a little muddled since the last inspection but it has been agreed that all activities undertaken or refused by individual service users is now documented in their daily record. A number of service users were asked about the meals at the home. They confirmed that they do get a choice and that the meals are well cooked and enjoyable. Menus were seen and found to have adequate variety of dishes to choose from. Choices made by service users were recorded. Service users are asked the previous day what they would like. Since many spoken to forgot what they had asked for, it was suggested that better would be to ask for service users’ choices to be offered on the day of the meal. Good choices are available by way of desserts and the teatime meal. The cook stays to cook tea. The cook was aware of diabetic diets, soft and pureed diets. The cook explained that they use fresh milk, vegetables and fruit where possible. The cook here is very enthusiastic and strives to improve the meals available for the service users. Two hot trolleys are used to transport the meals to the dining rooms. They were reasonably clean. However the probe used in one dining area was dirty with dried stale food. The staff did use the correct wipe to clean the part of the probe which is inserted in to the food but the display unit it self was unclean. The dining areas are light and airy and are set out in a pleasing way. Drinks are available throughout the day and some meals are served in service users’ rooms. Care still needs to be taken to make sure that food and drinks are not left to go cold when a service user needs help to eat or drink. Staff are not making sure that drinks are within easy reach of those who could manage themselves. They are also leaving the dining areas unattended when, according to the care plans, there are service users that need continuous encouragement and support. Cooksditch House Nursing and Residential Home DS0000023399.V344992.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users cannot be fully confident that they will be protected from abuse. EVIDENCE: The complaints system within the home was not looked at during this inspection but was found to be satisfactory during the last inspection. There has been a complaint received by social services about the home and this is subject to a current safeguarding adults strategy meeting. It was noted that although the registered manager did notify Social Services, the correct procedure was not followed. The registered manager now has now got a copy of the local authority safeguarding adults protocols, which should have been followed in this case. It is strongly recommended that she attend refresher training in the near future. Cooksditch House Nursing and Residential Home DS0000023399.V344992.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Service users cannot be confident they will be living in a safe, clean environment that is well maintained. EVIDENCE: A tour of the building was undertaken starting it the kitchen. It was found to be very greasy all over. Walls felt greasy, information posters in plastic pouches were black with grease and grime. The fly screens looked grimy and some had holes in. The windowsills were very dirty. The cooker and hood were clean and utensil and pots and pans were clean. The main food mixer was broken and in need of repair or replacement. It was strongly recommended that the kitchen receives a major professional clean. The records were well maintained and all temperatures recorded. Fridges were well stocked and the storage was appropriately undertaken. Open items were covered and dated. Cooksditch House Nursing and Residential Home DS0000023399.V344992.R01.S.doc Version 5.2 Page 18 The area behind dishwasher was filthy. Staff were aware but could not reach the space behind it so as to clean it. It is recommended that the dishwasher be pulled out periodically so cleaning can take place. The floor was heavily stained and in one area was coming away from the wall leaving a gap to trap debris. The floor needs a major clean or replacing. Staff confirmed that the floor is washed every day. Dishcloths were badly stained the staff said these are normally washed daily, but the stains never come out. It was recommended that disposable clothes be considered. The light diffuser was full of dead flies. This is directly over prep table. This was brought to the attention of the staff with the recommendation that the diffuser be cleaned regularly. The home did have visit form the environmental health officer in December 2006. The cook stated, as far she was aware the only recommendation was to deal with some flaky paint on the ceiling. Toilets and bathrooms around the home were generally not as cleaned to a good standard. For example, there were stained toilet bowls, dirty floors and skirting boards. The toilet seat in one toilet was very loose. Another with a raised seat had no handrails. Liquid hand soap and paper towels were available in each plus a bin with a lid for disposal. There was no lampshades and it one toilet there were tiles off the wall. The décor in bathrooms was stark and uninviting; they also had no lampshades; not a place for a relaxing soaks. This is not conducive to a homely atmosphere. One bathroom had a box with various items such as soap, talcum powder, several bottles of shampoo, sponges and flannels concerns were raised that these are being used communally. The sharing of such items poses a risk of cross infection. Staff should ensure that following the use of the bathroom all items belonging to service users should be returned to their rooms. The floor in one bathroom was dirty and the dirt looked ingrained. The bath hoists had been serviced with in the last six months as required under the LOLLER regulations. Generally around the home in corridors it was noted that skirting boards were dusty or dirty. A lot of doors were scuffed and chipped. Hoists had been left in corridors, sometimes dangerously. Slings attached to these hoists were examined and some were badly stained. Apart from the fact it is not nice for the individual service users to use them they could pose a risk of cross infection.. A large number of radiators covers seen showed signs that the paint had worn away and therefore could be a cross infection risk since they cannot be cleaned effectively. The carpet by the lift had come away from the gripper Cooksditch House Nursing and Residential Home DS0000023399.V344992.R01.S.doc Version 5.2 Page 19 rod as had the carpet on the steps leading from one of the dining rooms. Again this could be a health and safety issue. Some of the carpets seen were dirty and there was an offensive smell of stale urine in areas of the home that remained all day. It was queried whether the building has a problem with leaks as the ceiling tiles in lower corridor had many areas of water staining. The walls and ceiling in one of the lounges ceiling also showed signs of water damage. Under the stairs near room 58, 4 wheelchairs, footrests, specialist cushions quilts and blankets had been stored, some on top of metal cupboards. This was considered to be a fire hazard. The lounges gave a choice of different chairs for the service users to sit in. However, the placement in the room of some of these chairs made it difficult for staff to assist with mobility. The lounges were generally pleasantly decorated however water leaks/damp patches had spoilt the effect in some areas. In the dining room, on the residential side of the home, there is an old sideboard from which food is served. The top of the sideboard is worn away with no varnish left, making it impossible to clean effectively so as to prevent the risk of cross contamination. In bedrooms many wardrobes and cupboards were seen with items being stored on top of them. This can constitute a health and safety risk. The paintwork and carpets in some rooms were dirty and an offensive odour was also detected in some rooms. Some bedrooms were also dusty. One relative said that she had to dust her mother’s room because the domestic staff do not. There is notice on the ramp outside the doors by the main alarm panel stating ‘slippery when wet’ There was no identified risk assessment, no handrails had been fitted and no attempt to improve the surface to make it non-slip. Cooksditch House Nursing and Residential Home DS0000023399.V344992.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The home is operating a robust recruitment procedure however service users cannot be confident that the staff caring for them are sufficiently trained. EVIDENCE: The files of the last 4 staff to be employed were looked at each file contained evidence that CRB’s had been obtained as well as the required references. Evidence was also seen of suitable ID including photos via the passport photocopy. However, it was recommended that actual photos be obtained as in one case for example the passport photo was taken some years before and did not give a true likeness. The interview is recorded, but it was raised as a concern when it showed that a nurse was interviewed by the head of care who is not a trained nurse rather than the manager who was not available. There were no contracts seen in the staff files. However, evidence was seen that these had been given to staff but that they had no been returned signed. The home is now sending their staff on induction training and evidence was seen of the work set for staff which is then marked off by the home’s manager. The manager was asked to show that staff training had now been undertaken to ensure that all the required training plus specialist training to meet the needs of the service users had been undertaken. The manager was not able to Cooksditch House Nursing and Residential Home DS0000023399.V344992.R01.S.doc Version 5.2 Page 21 show all the up to date information but stated that not all the training necessary had been undertaken. There was evidence that some training had taken place since the last inspection, but the manager agreed that some certificates were now out of date. More courses were seen to have been booked, however the manager was unable to confirm if this would ensure all the staff would have the required training. The number of staff who have gained an NVQ Level 2 or above in Care remains low. This falls well below even the 50 target that was set previously. It is now expected that most staff will have gained this award. Trained nurses spoken said that they do not receive clinical supervision. The rotas were seen and the manager confirmed that there are 2 trained staff on duty when possible. The manager however stands in when this is not the case. The manager showed that there are normally 9 care staff on duty throughout the day. These staffing levels cover both the nursing and residential sides of the home. At night there are 4 staff on duty, one of which is a trained nurse. The number of domestic staff has increased but there is only one domestic staff on duty at weekends. Since the cleaning needs of the home do not change at all on a daily basis then this is not considered to be sufficient. It was also noted that the duties of absent domestic staff are not covered. As the home was found not to be clean throughout, an in depth clean was advised for some areas. It was strongly recommended that the manager reconsiders the number of domestic hours required to cover a home of this size. The home has 2 cooks normally but one is long term sick and the manager said she was hoping to employ a new cook in the near future. Meanwhile the existing cook is working nearly every day and the manager stated that she is also doing occasional shifts in the kitchen to ensure service users receive their meals. There are also 2 kitchen assistants that cover throughout the week. The manager confirmed the home does use agency staff to replace nurses and care staff during shortages. Cooksditch House Nursing and Residential Home DS0000023399.V344992.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users cannot be confident that the manager has the time to properly undertake all of her responsibilities. Service users are consulted about the approach of the home and are encourage to have their say. Service users cannot be confident that their health, safety and welfare are promoted by the home. EVIDENCE: The registered manager is well qualified for her position and has a number of years experience in residential nursing care both here and at a previous Cooksditch House Nursing and Residential Home DS0000023399.V344992.R01.S.doc Version 5.2 Page 23 establishment. The registered manager explained that she may have a planned period of absence in the near future. The home will need to organise a replacement manager during this time who is a qualified nurse and has suitable experience. Discussion with the manager during the inspection indicated that the proposed arrangement would not be acceptable. However the manager did indicate that a new deputy manager may be in post by then. The registered manager was reminded that she should formally inform CSCI with the arrangements. In the past there has been no deputy and the nurses on duty look after the nursing side. The head of care, who is not a trained nurse, oversees the residential side. At the time of this report evidence shows there has been a general deterioration of standards in this home and the manager was asked about this. She explained that she is often involved with the hands on nursing and that she has no administrative help and that she has had to do the cooking on occasions as well. It is apparent that she has not had time to attend to her responsibilities as the manager and this could be why standards have dropped. It is strongly recommended that more support be made available. Evidence was seen that service users are still consulted about things that happen in the home and a questionnaire has been sent out recently to get people’s views. Residents meetings are held periodically when enough service users attend. When this is not the case then service users are asked on an individual basis. The home has policies and procedures in place and evidence was seen that some have been updated for example the medication policy. This is not the case for all the policies however a number of these had not been reviewed with in the yearly time frame. The home’s policies and procedures remain accessible to all staff. Not all staff have received the required health and safety training, moving and handling or infection control training for example. The maintenance certificates were part of the last inspection in May and were not checked during this visit. Cooksditch House Nursing and Residential Home DS0000023399.V344992.R01.S.doc Version 5.2 Page 24 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 2CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 2 x N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X X X X X X 1 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X X x X 2 Cooksditch House Nursing and Residential Home DS0000023399.V344992.R01.S.doc Version 5.2 Page 25 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(2)(b)(c ). schedule 3(1)(b). Requirement 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. Previous time scale 30/07/07 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. Timescale for action 30/11/07 2. OP8 12(1)(a)( b). 13(1)(a)( b) schedule 3(3)(n) 01/11/07 3. OP9 12(1)(a) The registered person to ensure there are systems in place to DS0000023399.V344992.R01.S.doc 31/10/07 Page 26 Cooksditch House Nursing and Residential Home Version 5.2 4. OP9 13 (2) ensure that service users are not left without prescribed medication for continuing treatment. The registered person ensures 31/10/07 that medicines are stored within the correct temperature range so that service users do not receive medicines of reduced efficacy. The registered person ensures that complete and accurate records are kept of all medication administered, to demonstrate that service users receive their medicines as prescribed. 31/10/07 5. OP9 13 (2) 6. OP9 13 (2) 7. OP10 12(4)(a) The registered person ensures 31/10/07 that all unwanted medicines are collected from the home by a licensed waste disposal company, to comply with current legislation. The arrangements for health and 31/10/07 personal care ensure that service users’ privacy and dignity are respected at all times, and with particular regard to: personal care giving, including nursing, bathing, washing, using the toilet or commode, Service users wear their own clothes at all times The registered person ensures 31/10/07 that service users receive a varied, appealing, wholesome and nutritious diet, which is suitable for the individual service user, as shown in the assessment and recorded requirements, with assistance to encourage or help service user to eat as per their care plan or need. 8. OP15 16(2) Cooksditch House Nursing and Residential Home DS0000023399.V344992.R01.S.doc Version 5.2 Page 27 9. OP18 12((1) (a). 13(6) 17(1)(a) The registered person ensures that service users are safeguarded from any type of abuse, in accordance with up dated written policies as supplied by the local authority and by ensuring staff receive adequate training. Plus refreshers every three years 31/10/07 10. OP19 23(2)(d), (5). 16(2)(j) Previous time scale 30/10/06 The home should be accessible, 15/11/07 safe and well maintained; meets service users’ individual and collective needs in a comfortable and homely way and has been designed with reference to relevant guidance (See report for comprehensive list) The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection, in accordance with relevant legislation and published professional guidance. Make sure staff are employed and rostered in sufficient numbers and skill mix of qualified/unqualified staff are appropriate to cover the assessed needs of the service users, the size, the layout and purpose of the home, at all times. This requirement is regarding the numbers of domestic hours. 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 DS0000023399.V344992.R01.S.doc 11. OP26 12(1)(a), 16(1)(2)(j )(k), 13(3)(4), 23(1)(a)( d) 18(1)(a) 31/10/07 12. OP27 01/11/07 13. OP28 18(1)(a) (c) schedule 2(4) 31/03/08 Cooksditch House Nursing and Residential Home Version 5.2 Page 28 those members of the care staff who are registered nurses. 15. OP31 12(1)(a)( b) The registered manager is 31/10/07 qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. That there are clear lines of accountability with in the home with arrangements in place to cover periods of absence by the registered manager. The registered manager 30/11/07 communicates a clear sense of direction and leadership, which staff and service users understand and are able to relate to the aims and purpose of the home. The registered manager ensures 15/11/07 so far as is reasonably practicable the health, safety and welfare of service users and staff by making sure that staff undertake the relevant health and safety training, which includes moving and handling training yearly for example. Previous time scale 30/08/07 16. OP32 10(1), 12(1)-(5), 20 17. OP38 12, 13(3)(4)( 6) 16(2)(g) 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 During the pre assessment it is important to explore any cognitive impairment to ensure that the home is not admitting service users out category. DS0000023399.V344992.R01.S.doc Version 5.2 Page 29 Cooksditch House Nursing and Residential Home Cooksditch House Nursing and Residential Home DS0000023399.V344992.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Local 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.V344992.R01.S.doc Version 5.2 Page 31 - 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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