Inspection on 06/02/08 for Corner House Nursing Home

This inspection was carried out on 6th February 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 no outstanding requirements from the previous inspection report, but made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Corner House Nursing Home 12/01/09

Corner House Nursing Home 08/08/06

Corner House Nursing Home 13/10/05

Corner House Nursing Home 05/05/05

Corner House Nursing Home 21/09/04

Corner House Nursing Home 02/06/04

Corner House Nursing Home 20/01/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Sutton Lodge Nursing Home

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Corner House Nursing Home 116 Cheriton Road Folkestone Kent CT19 5HQ Lead Inspector Mrs Susan Hall Unannounced Inspection 6th February 2008 09:15 Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 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 Corner House Nursing Home DS0000026088.V357941.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 Adults 18-65. 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. Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Corner House Nursing Home Address 116 Cheriton Road Folkestone Kent CT19 5HQ 01303 258892 01303 258922 cornerhouse@counticare.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Counticare Ltd Margaret Everitt Care Home 19 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home with nursing (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) number of places 19 2. Physical Disability (PD) number of places 19 The maximum number of service users to be accommodated is 19 Date of last inspection 8th August 2006 Brief Description of the Service: The Corner House is a large detached building situated in a residential area of Folkestone. The building is in keeping with the local area and is close to the town centre, the local leisure centre and parks. It is owned by a company called Counticare, which was purchased by the company CareTech during 2007. This is an experienced provider for care homes in this category. They also own and run a day centre in Folkestone called the Martello centre, which is available for all the clients in this home to use. Accommodation is provided on 3 floors, all of which can be accessed by a passenger lift. There are 9 single bedrooms, 5 shared bedrooms and 2 with ensuite bathrooms. The home provides care and support to adults with physical and learning disabilities, and who also have nursing needs. Some have associated sensory impairment. Fees are arranged with the funding authority, depending on the individually assessed needs of clients. They currently range from £1500 - £1800 per week, with additional charges for hairdressing and personal items. Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. (NB. Where “we” is written in the report, this refers to “we, the Commission”. Only one inspector was involved in carrying out the inspection work). This was a key inspection, which includes taking into account all information gained about the home since the last inspection. This includes formal notifications to CSCI (which is a legal requirement to inform us); phone calls and letters to CSCI; any complaints; and the home’s Annual Quality Assurance Assessment. This is a self assessment form which the home is required to complete each year. The manager had been delayed in completing this, and telephoned CSCI several days before the inspection to apologise. The inspection included a visit to the home by one inspector, and this lasted for seven hours. The visit included reading documentation such as support plans, staff files, and medicine charts; viewing all areas of the home; talking with 6 staff and the manager; and meeting and observing clients in the home. Due to the nature of their disabilities, it was difficult to communicate effectively with clients, but they appeared generally happy and content. Survey forms were sent out, and 6 replies were received from relatives and health professionals. These included very positive comments about the staff, such as: “I am very grateful to the staff who are caring and kind people, and look after my relative well”; and “I am always very impressed by the commitment that the manager and team show to the residents. They know them as individuals, and show deep care and concern - it is always a pleasure to visit.” There had been one complaint received by CSCI during the past year, and this was reflected in one of the survey forms. The complaint was about the washing machine having been broken down “for a month”, and the survey form stated that “There should be better attention to jobs that need doing in the home e.g. there is only one washing machine for all the clients, and this did not work for several weeks.” What the service does well: Survey forms consistently spoke of the kind and caring nature of the staff, and their high level of commitment to providing good care for the clients. Meals are produced to a high standard, and provide a suitably varied and nutritious diet, with plenty of choice for clients. Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Maintenance of the home is generally poor and there are many outstanding issues which need to be addressed. The premises do not provide a homely environment for the clients. The company has been assessing some of these matters already and have been arranging for valuations, and reports from Occupational Therapists, to be carried out. However, the issues remain unresolved and no information has been provided to CSCI about decisionmaking in regards to these. Some of the issues are as follows: • Hard “ altro” flooring throughout the bedrooms, which looks very institutionalised. Old quarry tiles on bathroom floors and poor quality carpeting in some corridors. Damaged walls inside and outside the home. Bathrooms, which do not meet the needs of the clients and are a health and safety risk for staff to use. Broken equipment in the kitchen – e.g. a broken fly screen which allows flies into the kitchen. This is a health risk. A hot water dispenser that needs repairing which means that clients have to wait longer for hot drinks. A large pile of rubbish left outside (which is unsightly and a health risk). DS0000026088.V357941.R01.S.doc Version 5.2 Page 7 • • • • Corner House Nursing Home • • Inadequate storage facilities, so that storage is currently in a client’s shared bedroom, and in the conservatory. A conservatory which cannot be used, as it would contravene the privacy of clients using the bathroom or bedroom which it backs on to. There is no garden area outside for clients, and insufficient communal space inside the home. There is no sensory room, or area where they could be quiet, apart from their own rooms. Staffing numbers of support staff are too low to enable clients to go where they want and to do what they want. One relative commented in a survey that the staff had “hoped to bring their relative to visit, but this had not yet been possible because of staffing problems.” Insufficient training for staff in regards to understanding and working with clients with learning disability. Lack of regard for other legislation – e.g. fire requirements given one year ago have not been met. 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. Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 Quality in this outcome area is good. The home provides good information for prospective clients. The pre-admission process must ensure that all required equipment is in place prior to admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose has been updated since the last inspection and now includes all required information. It is nicely presented with a photograph of the home on the front cover. The service users’ guide has been totally re-written and is set out in large print in simple sentences, with “widget” symbols above each word. This makes it possible to talk through aspects of care with some of the prospective clients. It includes the complaints procedure, which is written in a straightforward style, with suitable symbols and pictures for explaining this to the clients. The manager stated that about half of the clients admitted would understand some of the way this has been written. All prospective clients have a needs assessment carried out prior to admission and joint assessments are obtained from care managers. The most recently admitted client was assessed by another manager from within the company. It Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 10 would be advantageous for the home’s registered manager (or her delegated person) to be involved in all pre-admission assessments, to ensure that this home can meet all the individually assessed needs. We (the Commission) were informed that necessary equipment was only obtained after the admission, and this is not satisfactory, as any required equipment must be in place prior to the admission. Contracts are prepared and agreed by the care manager on behalf of the funding authority, and agreed with the client’s next of kin or appointed representative. Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6-10 Quality in this outcome area is good. Support plans are well prepared and provide good details for carrying out ongoing care. Risk assessments are well managed. Attention must be paid to ensuring that confidentiality of information is maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each client is provided with a Support Plan, written and drawn up with their agreement and understanding as much as possible. Relatives and care management are also involved in the initial planning, and ongoing reviews. We looked at three care plans, and found them to provide good information to enable staff to care effectively for the clients. These are set out in sections, to enable easy access of information, and cover all aspects of care. For example, support plans include personal care needs; nutritional needs; moving and handling assessments and clear directions for staff; likes and dislikes (for food and activities etc.), mental state, Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 12 communication needs and leisure preferences. Support plans are reviewed on a monthly basis, and care manager reviews are held six monthly to begin with, and then yearly. Clients are enabled to make decisions as far as possible within the confines of limited understanding and limited communication. This includes how they wish to spend their pocket monies. Monthly allowances are received from the company’s head office, and stored securely. There are good procedures in place to ensure each person’s money is stored individually, and amounts are checked against receipts to ensure they tally. All receipts are retained. Most clients have severe learning and physical disabilities, and are limited in participating in making decisions about the life and running of the home. However, it was clear from observing interactions with staff and clients that the staff are quickly aware when clients are unhappy for some reason, and are able to interpret their reactions, and work out what they want. Clients are enabled to carry out choices of activities within a risk based framework. Risk assessments were viewed for moving and handling needs (e.g. transferring to different seating, use of hoist), and these contained clear directions such as the type of sling to use. All hoist transfers are carried out with 2 staff available. Other risk assessments include risks of spending time in their bedrooms unsupervised, with risks of falling from the bed or chair; risks for using bed rails and padded sides; risks for using wheelchair lap belts; and risks associated with behaviour management. Nurses and support workers write the daily records. Support plans are stored in a small office, which retains their confidentiality. However, individual information about clients was displayed on white boards in the dining room area, and this contravenes clients’ privacy and dignity. The manager was addressing this by arranging for the white boards to be moved into an adjoining staff office area, but had been hampered by lack of maintenance resources to physically move these boards. The information is transferred into individual records each day. Staff find that using the white boards is a quick method for recording details when they are busy with clients. Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11-17 Quality in this outcome area is adequate. There are sufficient opportunities for clients to develop their skills and to take part in different activities. However, staff are hampered in carrying these through by insufficient numbers of support staff and by a lack of facilities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Clients are encouraged to maintain existing skills and to develop new ones. These are in the form of very small steps, so that new goals are achievable. Staff record details for interaction with clients for individual “talk time”, where the interaction response is recorded as 1 for minimal response or up to 5 for maximum response. Over a period of time this shows a pathway of how clients are developing their understanding and ability to respond to staff. None of the clients are able to engage in work opportunities or jobs, but are enabled to carry out a good range of activities (when staffing is available). Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 14 These may include activities such as swimming or horse riding (if risk assessed as suitable), going to the company’s day centre (The Martello centre), or taking part in craft or musical activities. The Martello centre is open to all clients, but is very big, and is not suitable for clients who cannot cope with high levels of noise. However there is a “snoezelum” room there, which is enjoyed by clients. Transport is provided by the home’s own minibus. This takes wheelchair users, but most staff find that the ramp is too steep for pushing heavy wheelchairs up into the bus. There is no tail lift. The manager is waiting for a specialist winch to be fitted. There are currently 2 staff able to drive the bus. Clients also have the opportunity to go out to the theatre (the local Leas Cliff Hall is popular), discos, cinema, or sports centre. A hydrotherapy pool is being built nearby, and the manager is already arranging access to this. There is no snoezelum/sensory room in this home, which is a disadvantage for these clients. The support staff aim to carry out a group activity morning and afternoon for those who wish to take part. While this range of activities is available, there are insufficient staff to enable clients to go out and take part in things as much as they would like to. Clients have high dependency needs, and need two support staff for personal care; and many require two for moving and handling needs. Most clients need assistance with eating and drinking. In order to carry out the desired amount of activities, there needs to be an increased staffing ratio in the day times. (This is addressed under the Staffing section in this report too). Some clients like to be taken out to church. A local vicar visits on a regular basis, and carries out church services in-house for clients who wish to attend. Clients enjoy his guitar playing, and his interaction with them. However, it was noted in three support plans viewed that the clients’ religion had not been recorded. This should be documented, to ensure that clients’ preferences are respected. Activities are not currently well documented. One support plan showed only one entry for activities in the last 2 months. Most information is in the daily records, but it would be helpful if activities are clearly recorded separately to enable authorised persons to be able to see at a glance what clients are doing from day to day. Friends and relatives are permitted to visit at any time, and staff try to help clients to maintain family links (again, within the confines of low support staffing numbers). There is currently just one cook for the home, who has been employed here for many years and knows the clients’ likes and dislikes well. She also knows details about their different diets, and the right consistency of food for them (e.g. soft diet, or pureed foods). She prepares a variety of main courses and desserts each day, and had prepared three main courses on the day of the Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 15 inspection. This food looked very appetising, and provided a good choice. Most clients are unable to choose from the menu, but staff are doing all they can to encourage this. A staff member was in the process of taking photographs of prepared dishes, and a photographic menu is being prepared so that this may enable some to be able to choose. Support plans included detailed nutritional risk assessments, with directions such as “ offer food little and often”; “likes food not too hot”; “make sure he/she is positioned comfortably at the dining table”; “ use thickener in drinks”; and “ allow plenty of time as he/she is a slow eater”. Clients are referred to a Speech Therapist for assessments in regard to swallowing difficulties, and this advice is clearly written and adhered to. Breakfasts are prepared by the cook and given out by the support staff, and teatime meals are prepared by the cook where possible. Support staff prepare meals when the cook is off duty. This is a designated staff member, who does not carry out any personal care while allocated to the kitchen. Support staff do not carry out cooking duties unless they have completed a basic food and hygiene course. The manager is in the process of recruiting another cook. Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18-21 Quality in this outcome area is adequate. Personal and healthcare needs are well met by the staff in the home. Lack of suitable bathing facilities is hampering proper provision for meeting personal care needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Personal care needs are well documented in support plans, and include specific directions such as “ do not rush me”, or “ do not crowd me”. A personal care form is maintained to show when each client has been washed or bathed, and when they have had a hair wash, shave etc. There are clear instructions for items such as “ does not like an electric razor, and prefers to have a beard”. Clients were seen to be clean and dressed appropriately. The poor quality of bathing facilities is severely hampering the staff in carrying out good personal care, and it is a credit to the staff that they keep the clients so clean and attractive with such poor facilities. These are addressed specifically in the section for “environment”. One client cannot have a bath or shower at the home at all, as none of the facilities are suitable for this person’s Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 17 needs, and the client has to go to the Martello centre to have a bath/shower. This is extremely unsatisfactory, that a person is unable to have a bath or shower in their own home. This standard is rated as being poor in respect of the lack of equipment – not as a reflection of staffing capabilities. None of the four bathrooms are suitable for use, and they are not fitted with appropriate bath hoists or other equipment. Support plans show good management of health care needs. These include records of any bruises or injuries on body maps, monthly weight records, and “Waterlow” scores for assessment of general needs and pressure relief. Bedrails and padded sides were seen on beds, and were suitably risk assessed. The manager and staff are aware of the Mental Capacity Act, and a correct understanding of making judgements on behalf of clients who are unable to do so, if it is within their best interests. Decisions about these matters are taken on a multi-disciplinary basis –i.e. involving relatives, care manager, GP, and consultants as appropriate. Support plans include contact sheets with details of GP visits, Hospital visits, and input from other health professionals such as Speech Therapist, Occupational Therapist, Dentist, Optician and Podiatrist. Clients are visited in the home if it is difficult for them to go out to appointments. A physiotherapy aide visits the home for 16 hours per week, and carries out passive exercises for clients, and shows support staff how to do these. The home has a good working relationship with the Community Learning Disability Team. Fluid and food charts were seen to be well maintained where they are needed, and daily records included details of different aspects of care – nursing input, communication, health needs, eating and drinking and personal care. These records are appropriately signed, timed and dated. Wounds and pressure ulcers were documented on admission, and in daily records. However, wound care is not clearly documented on an ongoing basis, and there is a recommendation to ensure that wound progress is clearly identified, and the healing pathway can be clearly seen. Each dressing should be documented, with clear details of the state and size of the wound, and the dressing in use. Daily medication is stored in a locked medicine trolley in a locked room. The trolley was seen to be clean and tidy. Storage of other medication is in a clinical room, and this was well managed. There was no overstocking of medication, and no items were found out of date. All liquid medication is dated clearly as to when bottles have been opened. Some clients have their medication given in food, for ease of swallowing. Each client is assessed for the best method for them to take medication, and the process agreed with the care manager, GP, pharmacist and next of kin. Although the documentation is written as for “covert” medication, the manager stated that it is not actually a covert practice. Clients are given a clear explanation that “this is your Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 18 medicine” but it may be given in jam, for example, as the easiest method for them to swallow. Medication is given in liquid form where possible. Medication Administration Records (MAR Charts) are accompanied by a large photograph of each client. Handwritten entries are signed by 2 nurses. All MAR charts were viewed, and seen to be properly signed and completed. Support plans show details for clients/next of kin wishes in respect of death and dying. Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. Complaints are taken seriously and appropriately addressed. Clients are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is displayed on a wall in the entrance hall for visitors to the home, and it is separately written in a style suitable for explaining to clients. This includes details for discussing concerns with the manager and details for CSCI, but does not include details for Social Services. The manager said she would add this in to the procedure, to remind clients and visitors of this avenue for making complaints. One complaint has been received by CSCI since the last inspection. This was in respect of poor equipment maintenance, as there was no useable washing machine for about one month, and also the dishwasher was broken. The company have now replaced the washing machine, and the dishwasher is working. The manager had received some internal complaints to the home, and these were properly and appropriately addressed. Documentation was retained for these. A quality assurance survey sent to relatives brought to light some concerns which were dealt with. There was no clear complaints log in place, and the manager stated that she would implement this. Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 20 Staff are aware of the importance of the recognition and prevention of abuse with this vulnerable client group. Personal care is always carried out with 2 staff present in the room, and same gender care is given where possible. There are suitable protocols in place for the prevention of financial abuse. The staff training matrix showed that staff are kept up to date with adult protection training. Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24-30 Quality in this outcome area is poor. The premises are poorly maintained and do not provide a suitable and homely environment for clients. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The premises do not generally provide a good environment for clients. All areas were viewed. Maintenance has been allowed to slip, and there was much evidence of damage to walls internally and externally from a minor earthquake in the area last year. This includes damage to the plaster in bedrooms, and corridors on all floors. This is unsightly, and shows poor maintenance. Bedrooms have been recently painted, and are generally light and airy, but all the flooring is hard “Altro” flooring, which looks very institutionalised and is not at all homely. There are many better alternative opportunities for flooring now, which could make the whole home look and feel better for clients. Skirting boards and walls in corridors have been damaged by wheelchairs and other equipment, and have not been protected in any way. Furniture and Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 22 fittings in many areas of the home are old, and although functional, do not present a good appearance. Requirements given by the local fire service in February 2007 have not been met. Maintenance arrangements seem very inadequate. The staff document repairs needed in a book, and a maintenance person will be sent to the home every so often to deal with these. There are no set days for maintenance to be carried out, and no clear plan in place for the general upkeep and maintenance for the home to be addressed. The home was clean throughout, and had no offensive odours, and the cleanliness is a credit to the two domestic staff. Some of the bedrooms are quite small, which is reasonable if the client likes the room, and does not need much equipment. However, some rooms do not provide sufficient space for hoisting and wheelchair facilities, and clients must not be placed in rooms which are not suitable for meeting their assessed needs. One of the shared rooms on the second floor had a curtained area being used for general storage (i.e. not the clients’ belongings). This is not acceptable, as it is their personal room. Bedding and linen is gradually being upgraded. Some soft furnishings are of poor quality and do not enhance the home. Many of the clients’ specific chairs in bedrooms and lounges are falling apart and look very poor and uncomfortable. The manager was taking action on these where possible, with advice from the Occupational Therapist. Additional chairs for general use (i.e. for visitors, and clients who can use them) would be helpful in the lounge. Dining furniture is serviceable and adequate. There is only one lounge, and a small sitting area which has been created in the dining room. A conservatory built at the front is not useable, as it backs on to a bathroom and a resident’s bedroom, and therefore encroaches on clients’ privacy and dignity. This was being used as a storage area. It was also seen to be very damp, and has mould spores, which are unsafe for health care. Communal toilets and bathrooms are all inadequate (as previously documented in personal healthcare). There is one “Parker bath”, situated in the small bathroom on the second floor. The bath is positioned against a wall, and does not allow for a staff member to support the client each side. If a client should slip, this only enables help from one side. Two other bathrooms only allow access to the bath from one side, and the other baths are low, and unsuitable for staff health and safety. The bathroom on the first floor has overhead tracking in place for hoisting, but there is not enough space for 2 staff to assist clients with moving and handling needs from wheelchairs to bath. This is therefore unsafe for practice. A specialised bath support is broken, and there is no other fitted bath chair available. A bathroom on the ground floor has an old bath in it which cannot be used as the fixture is broken. It can only be used as Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 23 a shower facility, and the shower unit leaks. Another “bathroom” on the ground floor does not have a bath or shower unit at all, just a poor quality “changing table”. All of these bathrooms have old “quarry tiles” for flooring, some of which are broken and have poor fixings around baths and toilets. Some of the toilet seats were seen to be damaged. There are 2 other en-suite bathrooms, and neither of these are well set up either. One of the baths can be accessed from both sides, but not the other. Both baths are low, and unsuitable for staff assisting clients. There is no “wet room”, which would be an advantage for clients who prefer a shower. Radiators are covered with rusty wire mesh covers, which again, while functional, do nothing to improve the ambience of the home. There are requirements for the company to take action in respect of toilet and bathroom facilities; use of the conservatory; management of storage in bedrooms and conservatory; inadequate equipment; poor quality furniture and furnishings; meeting fire requirements; and general maintenance. A new sluice disinfector has been purchased in the last year, and is in use. A substantial hole has been left in the wall behind this, and could allow vermin into the home. This must also be dealt with. Laundry facilities are barely adequate, as there is no space for keeping dirty laundry separate from clean laundry, and the laundry room needs reorganising and refurbishing for good upkeep of infection control. The manager stated that a second washing machine is on order, which should prevent problems again for the home being left without washing machine facilities. The kitchen was viewed, and it was noted that the outer door was open, as the cooker hood fan does not work. The fly screen mesh on the back door is broken, allowing flies into the kitchen, and therefore poor infection control. There was a draught through from the back door to clients sitting in the dining room. The hot water dispenser/urn is broken, and staff were using kettles to boil water for drinks. This means that clients may have to wait longer for hot drinks. The hot trolley door does not close properly, so food is not kept as hot as it should be. Staff going into the kitchen to boil water for the kettles have to pass the food preparation area. Staff do not wear separate appropriate protective clothing when entering the kitchen, and this does not promote good infection control. There is no garden for clients’ use on these premises, but there is quite a wide concrete space at the side of the building, which is only used for the minibus storage, and 2 sheds. Some careful planning could enable the company to make a small, safe garden area for clients. There was a pile of cardboard and rubbish approximately 6 feet high and 6-8 feet wide stacked by the sheds. This is a pest control hazard, and therefore an infection control risk. (The pest Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 24 control official had already raised this as a concern.). An immediate requirement was issued for this to be removed. The company must put satisfactory procedures in place for the management of waste removal from the home. The manager showed us (the Commission) clear evidence that she has brought these matters to the attention of the company. This was recorded on faxed documents, and also on monthly (Regulation 26 visits) to the home, which were carried out by the Area Manager. Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31-36 Quality in this outcome area is adequate. Good recruitment procedures are in place, and staff are committed to providing good care. However, there are insufficient numbers of support staff on duty each day to meet all the needs of clients effectively. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had 15 clients in residence at the time of the visit. Staffing in the day time currently consists of 1 nurse and 5 support staff. There is 1 nurse and 2 support workers at night. The home is registered to take up to 19 clients. Staff are aware of their differing roles, and of their specific duties as key workers to different clients. However, it was clear that 5 support staff on duty were insufficient to enable the clients to have proper choices on a day to day basis about where they go and what they do. All need at least 1-1 support when going out, and there must be a driver as well. Some clients need 2-1 care when going out. This does not leave enough staff back at the home to carry out activities and proper time to communicate with clients left in the Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 26 home. Neither is there time for them to carry out individualised care and activities with clients. Staffing levels are also inadequate to enable clients to go out as much as they would like to, and when they would like to. Staff were seen to work well together, and to support each other. However, only 1 support staff has been trained to NVQ level 2, and more staff need this level of training to support them in their work. The manager said that another 3 had commenced this training, but opportunity and encouragement must be given to all support staff to carry out training to enable them to meet the needs of this client group properly. This includes specific training in learning disability. There are good recruitment procedures in place, ensuring that a full employment history is obtained, 2 satisfactory written references, and a POVA First and CRB check prior to commencing employment. Three staff files were viewed. The training matrix shows that mandatory training needs are being met (e.g. health and safety, moving and handling, adult protection, fire awareness, basic food hygiene), and nurses are enabled to keep their nursing skills up to date, and to develop these (e.g. with courses in PEG feeding, dementia). The home has a good basic induction programme in place, but this needs to include basic training in learning disability. Staff are supported via staff meetings, and by one to one supervision. This is carried out on a monthly basis, and is well managed. Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38, 39,42 Quality in this outcome area is adequate. The manager provides good leadership to other staff. Health and safety needs are not reliably met in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is registered with CSCI, and is suitably trained and experienced for running this home. She has a good rapport with the staff, and is an effective leader in all aspects of giving care to this client group. She keeps her own training updated. She had commenced NVQ 4 but has had to re-apply for this training due to some difficulties with the college concerned. Quality assurance is difficult to manage with this client group, but questionnaires were sent out to relatives during the past year. Some concerns Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 28 that were raised were dealt with. Other procedures include the manager’s own open door policy, and her daily presence on the “floor” with other staff. She carries out nursing duties on some days, but cannot be expected to do this frequently, as there are many management duties to consider. Other feedback is provided from staff meetings, and monthly visits by a company manager. Although mandatory training is in place for staff, (and this includes health and safety training), insufficient attention is paid by the company to health and safety needs. Requirements given by the Fire Officer in February 2007 have not been met. This includes general maintenance for the fire escape – which is very rusty; and replacing a window between the dining room and the conservatory with fire safety glass. As already mentioned, there is not a satisfactory procedure in place for the removal of some domestic waste products from the home. The pest control officer’s comments have not been heeded in regards to this. A hole has been left in a sluice room leading to the outside of the building. This could easily enable vermin to enter the home. Fire training has been given for most staff, but could not be evidenced as up to date for all staff. The manager and the administrator are expected to carry out fire training. While they have had some health and safety training, this does not necessarily provide them with the proper skills to train other staff in fire prevention. It is recommended that the company use an authorised fire officer, and ensure that training needs (and who gives the training) is consistent with the insurance policies for the home. Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 2 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 1 25 2 26 2 27 1 28 1 29 2 30 2 STAFFING Standard No Score 31 3 32 1 33 2 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 2 LIFESTYLES Standard No Score 11 3 12 2 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 3 3 3 3 3 3 X X 1 X Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 30 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 YA10 Regulation 12 (4) Requirement To ensure that confidentiality of information about service users is maintained; and service users’ privacy and dignity is upheld. This means that information must not be displayed on white boards for anyone to view. To ensure there is suitable provision in the home for places to carry out different activities suitable for meeting the needs of this client group. e.g. a sensory room; or a separate quiet room. Action plan to be provided by the given date. Timescale for action 06/03/08 2 YA14 12 (1) (3) 30/04/08 3 YA18 12 (1) (a) To ensure that personal care needs 06/05/08 for each service user can be properly met within the home, and that suitable equipment is provided for this e.g. specialist beds, bathing facilities. The providers must ensure that the premises are well maintained. This means that sufficient maintenance hours must be provided for the ongoing general upkeep of the home; and a clearly documented DS0000026088.V357941.R01.S.doc 4 YA24 23 (1) (a) and (2) (b,d) 30/04/08 Corner House Nursing Home Version 5.2 Page 31 maintenance plan must be put into place. This refers to repairs for walls, skirting boards, plaster damage etc. The hole in the sluice room wall must be repaired. The laundry room needs to be refurbished. A decision must also be taken about the state and siting of the conservatory, which encroaches on the privacy and dignity of services users, and is in a state of poor maintenance. To provide CSCI with an action plan for these items by the given timescale. 5 YA24 23 (2) (c) Items in the kitchen must be repaired: An immediate requirement was issued for the following: The broken fly screen on the back door must be repaired within 1 week, as it is an infection control risk; The cooker overhead fan must be repaired so that there is less need to keep the back door open so much (which is draughty for service users in the dining room). Suitable provision must be made for storage facilities in the home. Storage for home use must not be placed into service users’ own rooms; and storage should not encroach on service users’ communal space. 14/02/08 6 YA24 23 (2) (l) 06/04/08 7 YA24 23 (2) (b) To review flooring in bedrooms and 30/04/08 bathrooms, with an action plan to be provided by the given timescale. This should be replaced where flooring is broken (e.g. quarry tiles in bathrooms); and consideration should be given to improved types DS0000026088.V357941.R01.S.doc Version 5.2 Page 32 Corner House Nursing Home of flooring in bedrooms, to improve the homely quality of the premises. 8 YA25 23 (2) (e,f) To ensure that bedroom sizes are suitable for meeting the assessed needs of clients. Therefore, clients who, for example, need hoisting facilities, must be provided with a room suitable for the amount of equipment needed. The providers must ensure that there are sufficient numbers of bathing/shower facilities in place; and that these are designed in such a way as to meet service users’ assessed needs. An action plan is to be provided by the given timescale, showing the dates when the proposed work for bathrooms is to be carried out. 06/03/08 9 YA27 23 (2) (a,c,j) 30/04/08 10 YA28 23 (2) (e,g,h,i) 11 YA28 23 (2) (o) 12 YA33 18 (1) (a) The providers must ensure there is 30/04/08 adequate communal space provided for service users inside the home. An action plan is to be provided by the given timescale. To review the external grounds and 30/04/08 consider the possibility of creating a small garden area for service users. An action plan is to be forwarded to CSCI by the given timescale. To review the dependency needs of 06/04/08 service users against the numbers of support staff on day duty; increasing the numbers of support staff to ensure that all assessed needs of service users can be properly met (e.g. personal care; activities, outings). An immediate requirement was given to remove the pile of rubbish (mostly cardboard) stacked by the sheds. This is an infection control risk and a pest control risk. 14/02/08 13 YA42 13 (4) (c) Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 33 14 YA42 13 (4) (c) 15 YA42 23 (4) To ensure that proper procedures 06/03/08 are put into place for the ongoing management of waste disposal from the home. To ensure safe practices in regards 06/04/08 to fire prevention: Carrying out requirements made by the fire officer (these include maintenance for the fire escape, and replacing window glass in the window between the dining room and conservatory); And ensuring that fire training is carried out by persons suitably trained and competent for the task. These must be carried out with appropriate consultation with the fire authority. 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 YA3 Good Practice Recommendations To ensure that any equipment needed by new service users is in place prior to their admission; and for the manager to be involved in the decision making process about admitting new service users. To ensure that activities carried out are properly documented. And to ensure that religious preferences are documented. To ensure that any wound care is clearly documented, showing the state and size of the wound at each dressing change, and the type of dressing used. To review the quality of furniture and furnishings in bedrooms and communal areas, and upgrade as appropriate. To repair the hot water dispenser in the kitchen so as to provide a more efficient means of managing hot drinks for service users. DS0000026088.V357941.R01.S.doc Version 5.2 Page 34 2 YA12 3 YA19 4 5 YA24 YA24 Corner House Nursing Home 6 7 YA24 YA30 To repair the hot trolley so that it does not lose heat via the trolley door. To repair or replace rusty radiator covers. To review the processes for infection control when support staff access the kitchen; with a recommendation for support staff to wear alternative protective clothing when dealing with food. To continue to work towards 50 of the staff team achieving NVQ level 2 or above. To provide increased training for all staff which is specifically related to learning disability. 8 9 YA32 YA35 Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Oxford Office 4630 Kingsgate Oxford Business Park South Cowley Oxford OX4 2SU 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 Corner House Nursing Home DS0000026088.V357941.R01.S.doc Version 5.2 Page 36 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!