Inspection on 11/02/10 for Cornwallis

This inspection was carried out on 11th February 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cornwallis 22/10/09

Cornwallis 28/07/09

Cornwallis 23/10/08

Cornwallis 02/11/07

Cornwallis 23/05/07

Cornwallis 22/05/06

Cornwallis 24/02/06

Cornwallis 05/09/05

Cornwallis 03/03/05

Cornwallis 20/09/04

Cornwallis 08/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 25/04/2010.

Random inspection report Care homes for older people Name: Address: Cornwallis Trewidden Road St Ives Cornwall TR26 2BX one star adequate service 23/10/2008 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Diana Penrose Date: 1 1 0 2 2 0 1 0 Information about the care home Name of care home: Address: Cornwallis Trewidden Road St Ives Cornwall TR26 2BX 01736796856 01736797143 cornwalliscare@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Cornwallis Care Services Limited care home 51 Number of places (if applicable): Under 65 Over 65 51 51 dementia mental disorder, excluding learning disability or dementia Conditions of registration: Date of last inspection Brief description of the care home 0 0 2 8 0 7 2 0 0 9 Cornwallis Nursing Home is a detached property located above the town of St Ives, Cornwall. It is a three-storey dwelling and is situated at the top of a hill. The home offers nursing care for up to fifty-one elderly residents with a dementia or mental health problem. Residents accommodation is spread over three floors. Private bedrooms are shared or single, with bedrooms on the first floor having en suite provision. There are two communal lounge / dining areas, plus a conservatory, which has sea views. All rooms have call bells and assisted bathing facilities are provided. The garden area is accessible to residents. There are opportunities for socialising and visitors are openly encouraged. Information about the home is available in the form of a residents guide, which can be Care Homes for Older People Page 2 of 13 Brief description of the care home supplied to enquirers on request. A copy of most recent inspection report is available in the home. Fees range from 530 to 750 pounds per week according to the manager, who supplied this information during the last key inspection in October 2009. Additional charges are made in respect of private healthcare provision, hairdressing and personal items such as newspapers, confectionary and toiletries. Care Homes for Older People Page 3 of 13 What we found: Three inspectors visited Cornwallis Nursing Home to investigate concerns raised to the Commission. The concerns were in relation to staffing levels not being sufficient to care for residents needs, for example only one carer in the lounges when the others are bathing people, dietary issues including cheap food, not enough and no choice, restraint by keeping almost all residents in one lounge and management is poor. Prior to and following this visit, we gained the views of four healthcare professionals who visit the home. Their views were that staffing levels seem to be low for the number and dependency of the residents and that staff turnover is high. Comments include The staff seem to be struggling to provide the care required in the home, Not enough staff and The home has been struggling for years but there is nothing glaring or persistently wrong. They all said that the staff are kind, caring and courteous and the nurses are good but there are not enough of them. Part of this visit included dementia mapping observations, sea view lounge was observed for an hour in the morning and garden lounge for an hour over the lunch period. We also spoke to staff and examined records as well. We had been informed prior to this visit that the manager was no longer employed and that the Operations Director, Facilities Manager and a Registered Mental Nurse (RMN), as clinical lead, were now running the home. When we arrived we were told that none of the management team were due to work that day, however they all arrived at the home when the nurse informed them we were there. There was a Registered General Nurse (RGN) in charge with five care staff, two agency care staff were also on duty undertaking one to one care for two residents. There was an administrator, a cook, a new kitchen assistant and housekeeping staff on duty as well. We were told that there were 29 people accommodated plus one person receiving day care. We arrived at 09.30 hours and observed that twenty six residents were up and dressed and sitting in the lounges or seating areas between the lounges. Throughout the day we saw residents moving about freely between the two lounges. We asked why there was a rope across the bottom of the stairs and the member of staff was not sure. She told us that some people take it off when they want to use the stairs but it acts as a deterrent, especially for those who are unsteady on their feet. We examined the personal hygiene records and they told us that 17 people had been given a full wash by the night staff and that 3 people were self caring. At 09.50 there was no care reflected for the remaining 9 people. We questioned the reason for the high number of people given a full wash so early in the morning. The Registered Nurse told that not all would have had a full wash and the paperwork could not have been completed correctly. This issue was fed back to the management team. We saw one person assisted to the bathroom for a full bath but we noted that most of the residents in the garden lounge did not leave the room and therefore could not have received any personal care. We examined 10 care files. We looked at the risk assessments undertaken for 8 people to Care Homes for Older People Page 4 of 13 ascertain levels of dependency and the amount of assistance they require from staff. The records told us that one person was cared for in bed, 6 had bed rails in situ and one person slept on a mattress on the floor, 5 people were at a high risk of falling and 6 had high moving and handling risks, 7 needed two care staff for mobilising and transfers. All 8 were at a very high risk of developing pressure sores and 2 people had developed sores which the records showed were improving. 7 people had been identified as having high nutritional risks and 5 of the 8 people were having their food and fluid intake recorded on specific charts, although we did not see anyone needing a stipulated amount of fluid intake. We examined all of the food/fluid charts from 06 February 2010 and found that the recordings were very variable. Some stated a cup of tea for example, whilst others stated 150 or 200ml of tea, there were no totals recorded. A nurse told us that nutritional supplements were prescribed however very little was recorded on the food charts. Some records stated a meal was eaten whilst others described what was eaten and how much. The charts commenced at 09.30 each day and ended at 12.30, 15.00 or 19.00. We were told that breakfast commences at 09.30, lunch is served at 12.30 and the teatime meal is served at 16.30. We were also told that hot drinks are served at 19.00 when sandwiches are available but those on a liquidised diet just have a drink. We were told that drinks are offered overnight or given on request. We saw no evidence to support that residents have fluids or diet from 19.00 until breakfast. The cook told us that he makes sandwiches for residents to have overnight if they wish, for example, jam, cheese or ham and sometimes there is soup. He said there were also biscuits, a selection of fruit and salad. We saw that jugs of water and fruit squash were available in the lounges during our visit. We spoke with the cook and we looked around the kitchen, the dry store, fridges and freezers were well stocked. There was a board that detailed residents names and the type of diet they had, for example, normal, liquidised, vegetarian, diabetic and no pork products. A concern had been raised that a vegetarian resident eats fish every day and she did have fish during this visit. Her care plan stated that she particularly liked fish and the cook said this as well, he told us that sometimes she has other meals such as jacket potatoes, eggs or mushroom stroganoff but there were no records to evidence this. The menus showed that a set meal was on offer each lunch time and this was written on a board in each lounge. The cook said he liaises with the nurses each day as to what residents would like. He told us that alternatives to the menu were available but food records have not been maintained to evidence what people actually have, despite the issue being discussed with the cook at the key inspection on 22/10/09. The cook told us there was always plenty of food and orders were based on the menu and approved by the Facilities Manager. He said she rarely changed the food order. We saw the meat order that had arrived during our visit, The cook explained that the two 6.8kg lamb joints would not be used for one meal some would be frozen for another time. We asked the cook how much chicken he would cook for 29 residents. He told us that two 3kg chickens would provide a roast dinner for residents and staff and some would be left over for sandwiches. We observed that the lunch time meal was lamb stew served with green beans and potatoes with rice pudding for dessert. The portions were not large but most people ate their meals and seconds were offered. Staff were offering alternatives to residents in Care Homes for Older People Page 5 of 13 particular one resident who would not eat. We saw the liquidised food on offer and the cook said there were three different vegetables and all of them were liquidised together rather than separately. If they were separate it would be more pleasing on the eye and allow people the choice to eat the vegetables they like; we discussed this with the cook as we did at the last inspection and gave feedback to the management. We also observed a one residents liquidised meal which was served in a dessert bowl and the meat, potatoes and vegetables were all mixed together. Staff offered suitable assistance with the lunchtime meal although it would have been more difficult had the clinical lead nurse not been there to support the staff. One resident had no table or tray, her plate of food was put in her lap but she did manage to eat it. Staff interacted well with residents and appeared kind and caring. There was more activity and interaction taking place in the sea view lounge during the morning than in the garden lounge where people were sitting and falling asleep. However interaction was better over the lunchtime and the atmosphere improved when the activities co-ordinator came in and music was put on. Some people were asked if they wanted to go to the other lounge to make Valentine cards. Later a film was put on and some of the residents were watching it. We asked the nurses and care staff about the staffing levels. They told us that generally there were five care staff and one nurse during the day. Staff said that two carers are allocated to each lounge and one worked between the two. They told us that sometimes there were six care staff which works much better and allows more staff on the floor whilst residents are being bathed and so on. The nurses said they are kept very busy especially on days when there are doctors rounds, health professional visits or care reviews. The nurse in charge during this inspection would have been under more pressure if the clinical lead nurse had not arrived. They told us that two nurses during the daytime would be better and that when the manager was there they did have another nurse around if needed. The nurses told us they would contact the community specialist nurses if they had concerns. We were told that there were four nurses currently employed, two RMNs on nights and an RGN and RMN (clinical lead) on days. We were told that an RMN from another home in the group and agency nurses cover when necessary. We were told that agency care staff provide 1:1 care for three residents at stipulated times and we observed 1:1 supervision taking place. The cook told us that there were three cooks but one walked out in January and has not yet been replaced. A kitchen assistant was working her first shift in the home on the day of this inspection. We were told that the Operations Director compiles the duty rota with input from the nurses. He told us that the numbers on duty are calculated by the number of residents taking into consideration their care needs. We were given copies of the duty rotas and corresponding deviation sheets for the past three months and these showed that a qualified nurse was on duty at all times. They showed that generally there were five care staff during the daytime and two at night and staff tended to work twelve hour shifts. Sometimes there had been six care staff during the day. Concerns were raised to the Commission about the care staffing levels particularly at weekends. The rotas showed that at weekends the daytime care staff numbers vary, for the 30 weekend days on the rotas there were 14 days with 5 care staff on duty, 9 with 4, 5 with 3 and 2 with 2. These figures included agency staff working as part of the care team, not the 1:1 care. The deviation sheets have recordings of short staffed on several occasions. The records show that a nurse worked two consecutive twelve hour shifts on one occasion Care Homes for Older People Page 6 of 13 and has recorded working 24 hours as a double shift, which is not safe practice and raises concern. We discussed staffing with the Operations Director who named six staff that have left since June 2009 and six that have been employed since October 2009. He told us he is advertising for a manager, qualified nurses, care staff and a cook. We inspected the staff files of the newest care staff and the clinical lead nurse. Relevant checks had been undertaken and contracts of employment were in place. There were no interview records for the promotion of the clinical lead nurse and no references had been obtained for this particular role. A new carer was commencing a night shift on the date of this inspection, the duty rota showed that she was to work with another carer and a nurse; she was not supernumerary. We were told that another night carer was coming in to undertake the induction of this carer but she was not on the rota for the night. We saw the completed induction pack for a carer who commenced work in January 2010. We were told that the Skills for Care induction packs were to be implemented at the end of February. A kitchen assistant commenced work on the day of this inspection she told us she had not completed an induction programme yet but had been shown the fire escapes and how to turn off the gas. We were given a copy of the staff training matrix. Requirements were notified at the key inspection on 22 October 2009 that all staff must receive relevant training in respect of safeguarding adults, with a time scale of 25/01/10. Also that all staff must receive suitable training in fire prevention with a timescale of 29/01/10. The records show that these timescales have not been met. However the Operations Director has confirmed by e-mail that the remainder of the staff will attend Protection of Vulnerable Adults training on 17 February and 01 March and Fire training on 22 February. The requirement timescales have been extended. We noted that the home was warmer than it was in October but pointed out to the Operations Director one corridor area that was cold. We were told that quotes had been obtained for the heating and also for the refurbishment of the downstairs bathroom and the provision of two wet room showers. We were shown the quotes and told that work is to commence on 01 March 2010. What the care home does well: What they could do better: Employ and deploy sufficient nurses and care staff to meet the individual needs of people using the service. Care Homes for Older People Page 7 of 13 Employ a manager to be registered with the Care Quality Commission who can provide leadership and direction for the staff. Ensure that record keeping is completed appropriately and efficiently by all staff and fulfils the reason for its use. Ensure that they can evidence that residents, assessed as nutritionally at risk receive appropriate and sufficient diet, fluids and where necessary supplements, over each twenty-four hour period. Ensure that food records are maintained each day to evidence what individual residents have to eat. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 18 12 All staff working in the home 05/03/2010 must receive relevant training in respect of safeguarding adults. To ensure that they are knowledgeable on what to do to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. 2 21 12 Appropriate bathing facilities 30/06/2010 must be provided, that are suitable for elderly people including those requiring assistance. This will ensure peoples health and welfare is provided for in an appropriate manner. 3 30 18 All staff must receive training 29/03/2010 appropriate to the work they perform and the client group including structured induction training. To ensure that at all times suitably qualified, competent and experienced persons are working at the care home. 4 38 23 All staff working in the home 05/03/2010 must receive suitable training in fire prevention Page 9 of 13 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action and fire drills must take place at suitable intervals. This will ensure so far as practicable that staff know what to do in the event of a fire to protect people using the service, staff and visitors. Care Homes for Older People Page 10 of 13 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 15 17 There must be a detailed record of the food provided for people using the service. To determine that the diet is satisfactory in relation to nutrition and of any special diets prepared for individuals. 05/04/2010 2 27 12 Sufficient nurses and care 05/04/2010 staff must be employed and suitably deployed. To ensure that the care home is able to promote and make proper provision for the health and welfare of people using the service. To include their care, and where appropriate, treatment, education and supervision. 3 31 8 A manager must be appointed and be registered with the CQC To run the home and to provide leadership for the staff 28/06/2010 Care Homes for Older People Page 11 of 13 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 37 Record keeping should be completed appropriately and efficiently by all staff and fulfil the reason for its use. Care Homes for Older People Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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