Inspection on 25/01/06 for Cornford House

This inspection was carried out on 25th January 2006.

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

Other inspections for this house

Cornford House 25/04/07

Cornford House 13/04/05

Cornford House 15/09/04

Cornford House 06/04/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

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 Cornford House Cornford Lane Pembury Tunbridge Wells Kent TN2 4QS Lead Inspector Maria Tucker Announced Inspection 25th January 2006 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 Cornford House DS0000039710.V267825.R01.S.doc Version 5.0 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. Cornford House DS0000039710.V267825.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Cornford House Address Cornford Lane Pembury Tunbridge Wells Kent TN2 4QS 01892 822079 01892 822796 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) www.cornfordhouse.co.uk Cornford House Ltd Mrs Linda Margaret Wenham Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Cornford House DS0000039710.V267825.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th April 2005 Brief Description of the Service: Cornford house is a care home with nursing. Cornford House is a detached property standing in 10 acres of gardens on the outskirts of Pembury. There is a bus stop approximately 100 yards away with buses to Tunbridge Wells and Tonbridge. On site car parking is available. The home is arranged on three floors and there is a shaft lift. There are 30 single bedrooms, two of which have en-suite facilities. Each room has a staff call point and a television point. OMF international who support evangelistic work oversees previously owned the home; the home was originally opened to meet the needs of retired missionaries. Therefore, Cornford House has a strong religious focus with prayer meetings being central to life in the home. The home employs qualified and care staff that work a roster that gives 24-hour cover and other staff for catering, domestic and maintenance duties. Cornford House DS0000039710.V267825.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, the second in the year running from April 1st 2005 to March 31st 2006. The inspection lasted from 09.15 until 15.00 the inspection was conducted by the lead inspector Mrs M Tucker. Time was spent meeting the manager and deputy manager and going through various records and documentation. About one and a half hours was spent meeting service users collectively and individually. One relative were spoken with. Due to the health of some of the service, it is difficult to gain a full picture of their quality of life, this was made through judgements from observations, speaking with staff and looking at records. A partial tour of the premises was made which included service users rooms and communal areas. The pre inspection documentation was received by the CSCI. 18 comment cards were received from service users, comments included: • “Good senior staff. Exceptionally helpful. Rest of staff good” • “I am very happy and well cared for” 14 comment cards were received from relatives/visitors, comments included: • “I am satisfied with the care my receives, and all the staff are very helpful and willing to do anything for ” • “Out of the 7 residential homes I looked at Cornford House came out top. The management is excellent” 6 comment cards were received from health and social care professionals, comments included: • “I am always made welcome in the home and have developed a good professional working relationship with the manager. The home is calm and appears well run which provides a pleasant environment for residents and staff”. It is recommended that this report be read in conjunction with the last inspection report to enable the reader to gain a full picture of the home, as some of the standards that were inspected and met during the last inspection were not inspected during this inspection. What the service does well: Cornford House DS0000039710.V267825.R01.S.doc Version 5.0 Page 6 Cornford House continue to meet the spiritual needs of the service users. Visitors continue to be made welcome. A comment received from a relative/friend “I’ve always found the atmosphere to be a happy and peaceful one. They are lovely people staying there and lovely staff”. Service users continue to receive a good standard of care based upon individual choice and preferences. Service users commented “The night Sisters particularly good, if you wake up they support you”. Throughout the inspection service users spoke highly of the staff. Service users health and well-being is monitored and maintained through a detailed care planning system. This is regularly updated and reviewed. The home has good systems in place for infection control and health and safety checks. Staff spoken with who worked in the kitchen and laundry areas were clear about the policies and procedures. The home has a good menu that caters as far as possible for individual tastes and preferences. Without exception everyone commented that the food was appetising and good. What has improved since the last inspection? What they could do better: Two negative comments were received from service users “when sitting in the bath another staff member sometimes comes in” and “Some carers seem too hurried to do all I require”. One negative comment from a relative/friend “Some staff should show quiet and un-hurried attention and not make the disabled person feel they are being a nuisance calling for assistance”. These were discussed during the inspection and the manager will address these issues with staff. Formal regular recorded supervision for the manger. To re assess the rooms and equipment fit for purpose when there has been a change in need or a service users condition. Cornford House DS0000039710.V267825.R01.S.doc Version 5.0 Page 7 The firming up of PRN (when required) medication and the medication procedure for administering medication to service users in their rooms. 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. Cornford House DS0000039710.V267825.R01.S.doc Version 5.0 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 Cornford House DS0000039710.V267825.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 standards 1, 2, 5 were met during the last inspection. Service users can feel confident that they will only be admitted following a full assessment of their needs and that the home are able to meet these. EVIDENCE: Service users are given confirmation that having regard to the assessment the care home is suitable for the purpose of meeting their needs in respect of health and welfare. The care plans do contain assessments of service users daily living needs including leisure and recreation. Perspective service users have a full assessment undertaken to establish their needs and ensure that the home can meet these. Cornford House DS0000039710.V267825.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 9, 10 standard 8 was met during the last inspection. Service users are supported well with their health and welfare needs. EVIDENCE: Service users spoken with were familiar with their care plan and confirmed that they had meetings to discuss their care. From document reading and case tracking a change in health need had occurred and a review arranged to discuss this. Qualified staff dispenses the medication only. It was discussed that the home could improve their system of dispensing medication to service users in their rooms as currently the medication trolley is left unsupervised. The monitoring and use of PRN medication would benefit from being firmed up with pain assessments conducted. Service users whom are assisted to self medicate must have a risk assessment in place. Overall service users spoken with expressed that the staff were very responsive in assisting them with their medication. Good practice was evident in action taken to meet individual needs. A comment received from a service user stated “More information on medication” One comment was received from a service user who stated a staff had come into the bathroom while they were being assisted. The manager will address Cornford House DS0000039710.V267825.R01.S.doc Version 5.0 Page 11 this. The comment cards indicated that staff treat service users with dignity and respect. Service users spoken with confirmed this. Cornford House DS0000039710.V267825.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 standard 14 was met during the last inspection. Service users visitors are made welcome. Service users are encouraged to choose from planned activities or to relax watching the television or listening to music. The food is of a good quality with variety and choice. EVIDENCE: During the inspection service users were undertaking a range of activities. One service user in their room was listening to music and singing, others were watching television or reading. An exercise class was well attended. Service users spoke of how they could join in the activities, which included prayer meetings. The garden party held in the summer was particularly enjoyed. Visitors were seen to come and go freely and were made very welcome. A visitor detailed how they visit regularly and stay all day. Stating they have the occasional meal, which is very good. Stating “I am very well catered for when I come in”. A comment made by a service user in the comment card stated ‘Meals excellent”. The menu offers variety and choice with fresh meat and vegetables. Staff monitor food intake and encourage and support service users with poor appetites. Breakfast is served in service users rooms and lunch and tea can be taken in the dinning room or in private. Cornford House DS0000039710.V267825.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18. Service users can feel safe, protected and listened to. EVIDENCE: Comments received in the comment cards evidenced that service users and their relatives would complain and would feel comfortable to do so. Service users spoken with had no complaints or could they think of how the service could be improved. One comment received from a relative stated, “I feel I can talk about any worries I might have with the management”. A staff member has completed the training on adult protection to enable them to provide training to staff. There has been no adult protection alerts raised since the last inspection. Service users spoken with stated they feel safe. Some service users have their families act as advocates others have a care manager or friends. Cornford House DS0000039710.V267825.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24, 25, 26 Overall service users live in a comfortable well-maintained homely environment. The garden and grounds are not fully assessable. EVIDENCE: Service users who are not fully ambulant or require aids are limited as to the use of the gardens due to the uneven surfaces and paths. The grounds were un-kept with shrubs, borders and pathways requiring attention. Some general maintenance work to the gardens has been done. The areas seen were well maintained and homely. Service users rooms were very personalised to individual tastes. The home was very clean and tidy. The home has several rooms for communal use or to meet with visitors in private. One sun lounge was found to be cold. It was recommended that the room temperature be monitored and action taken accordingly. Routine regular maintenance of the home is undertaken. The maintenance and associated records in the pre inspection questionnaire lists these. They were Cornford House DS0000039710.V267825.R01.S.doc Version 5.0 Page 15 spot checked during the inspection. One service user commented that their electrical equipment had been tested. It is recommended that the hallway carpet identified during the inspection is made flat. It is very strongly recommended that when a service users health or mobility needs change a reassessment of their private accommodation as to fit for purpose be undertaken. Not all of the private rooms had adjustable beds. It was discussed that if a service users is receiving nursing care this would need reassessing and an adjustable bed may be required to be provided. The passenger lift is too small for a wheel chair. A glide about chair is used and staff push the chair in and collect service users at their destination. The lift company acting on behalf of the homes proprietor is of the view that “If one to one assistance is given to patrons when use of the lift is necessary, then that should be a safe situation. To be precise we visualise that when a standing disabled person is helped into the lift with an accompanying assistant, then that is wholly adequate”. When a specially provided wheelchair is used to put a disabled person in the lift they express the view that “The procedure sounds safe”. The view from the health and safety executive being ”The situation where the resident is placed in the lift and left in the lift with no escort, raises issues regarding the potential care of the resident should the resident require medical attention and/or care for the duration of their time in the lift”. Furthermore the lift at Cornford house has been examined in accordance with the lifting operations lifting equipment regulations 1998. As discussed at previous inspections the manager must continue to risk assess all service users who use the lift in respect of their health and welfare. That all prospective service users are assessed and not admitted into the home if the assessment indicates the lift is not fit for purpose for that individual. Regular reassessments must be made with any changes of need. Not all of the hot water taps have restrictors fitted locally. Regular testing is conducted to monitor the temperature. The highest recorded being 46oC. It is recommended that risk assessments be undertaken and restrictors fitted where it is identified as being needed for health and safety. It is recommended that in the communal hallway areas a closed laundry bin be provided. That service users food that is out of date is removed from the fridge. Cornford House DS0000039710.V267825.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Service users benefit from a stable trained staff team who understand the needs of this client group. EVIDENCE: Service users were very complementary about the staff and manager. A particular comment was made as to the support at night. Some service users expressed that occasionally they waited for their call bell to be responded to during busy times. The manager is addressing this through looking into the times and tasks and has already altered the starting time for staff. The Department of Health Residential Forum calculated staffing hours based upon the needs of service users in the pre assessment questionnaire is 762.33 duty hours; 599.26 care hours; 20.40 recreational hours; 19.06 full time staff. The staff rota provides 5 care staff am and 4 care staff pm; 1 RGN am and pm; 2 waking care staff, 1 waking RGN. Total 546 weekly care assistant hours; 10 hours recreational/activity co-ordinator; 168 RGN hours Total hours provided 724. Extra staffing is provided for cooking, cleaning and maintenance. The staff training has increased, training undertaken included fire training lectures; adult protection; manual handling; vulnerable adults; food hygiene; verification of death; tissue viability; first aid; peg and nutrition; speech and swallowing; wound care; nutrition. Cornford House DS0000039710.V267825.R01.S.doc Version 5.0 Page 17 The commitment of the home to ensure that 50 of care staff are trained to NVQ level 2 or above continues with staff undertaking and almost completing this. Staff files evidenced the home has a robust recruitment policy and procedure that they follow. It was discussed that the files would benefit from a checklist at the front of the files for tracking and monitoring. Cornford House DS0000039710.V267825.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Service users benefit from a well run and managed home. EVIDENCE: The manager has gained the RMA award. From the improvements made to the home since the appointment of the manager and the comments received, it is evidenced that the manager is competent, highly respected and committed to providing a good service and place to work. A comment made by the elderly nurse specialist “The home is calm and appears well run which provides a pleasant environment for residents and staff. I have developed a good professional working relationship with the manager”. The role of deputy manager in supporting the manger is very effective and assists in the smooth and competent running of the home. The home is pro active in seeking the views of the service users and other stakeholders. Regular meetings to discuss the home are held between the management, staff and service users. Cornford House DS0000039710.V267825.R01.S.doc Version 5.0 Page 19 A customer satisfaction survey from an external agency for relatives has been conducted as part of the improved monitoring and reviewing of the home. Service users spoken with expressed that they feel they are informed of changes and kept up to date. The manager only receives clinical supervision. The records viewed were as far as it is reasonably practicable to ascertain accurate and up to date. It was discussed that the freedom of information act may have an impact upon the homes record keeping. It was also discussed that the home could benefit from a policy on living wills should the need arise. Cornford House DS0000039710.V267825.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 X 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 X 2 X 3 2 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 3 3 Cornford House DS0000039710.V267825.R01.S.doc Version 5.0 Page 21 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 OP9 Regulation 13 (2) Timescale for action The registered person shall make 08/03/06 arrangements for the handling, safe keeping, safe administration of medicines received into the care home. As identified in the text. The registered person shall 08/03/06 having regard to the number and needs of the service users ensure that external grounds are suitable for and safe for use by service users. The registered person shall 08/03/06 having regard to the number and needs of the service users ensure that the physical design and layout of the premises to be used as the care home meet the needs of the service users. As identified in the text. Requirement 2 OP19 23 (2) (0) 3 OP22 23 (2) (a) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Cornford House DS0000039710.V267825.R01.S.doc Version 5.0 Page 22 No. 1 2 3 Refer to Standard OP19 OP19 OP19 Good Practice Recommendations It is recommended that the temperature of the sun lounge be monitored. It is recommended that the hallway carpet identified during the inspection is made flat. It is very strongly recommended that when a service users health or mobility needs change a reassessment of their private accommodation as to fit for purpose be undertaken. It is recommended that risk assessments be conducted for those hot taps that do not have fail-safe devices fitted locally. That when the assessment identifies a need a failsafe device is fitted. It is recommended that in the communal hallway areas a closed laundry bin be provided. That service users food that is out of date is removed from the fridge. It is recommended that the home continue to support the care staff with NVQ level 2 training to meet the 50 target. It is recommended that the staff files contain a checklist at the front of the files for tracking and monitoring. It is very strongly recommended that the manager receive formal supervision in addition to clinical supervision. It is recommended that a policy for living wills be devised. It is recommended that the home updates its policies and procedures taking into account the freedom of information act. 4 OP25 5 6 7 8 9 10 OP26 OP28 OP29 OP36 OP37 OP37 Cornford House DS0000039710.V267825.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cornford House DS0000039710.V267825.R01.S.doc Version 5.0 Page 24 - 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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