Inspection on 02/11/07 for Cornwallis

This inspection was carried out on 2nd November 2007.

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

Cornwallis 11/02/10

Cornwallis 22/10/09

Cornwallis 28/07/09

Cornwallis 23/10/08

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

Similar services:

Fairfields Country Rest Home

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Fairfax House

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

CARE HOMES FOR OLDER PEOPLE Cornwallis Trewidden Road St Ives Cornwall TR26 2BX Lead Inspector Diana Penrose Key Unannounced Inspection 2nd November 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cornwallis DS0000009008.V349653.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cornwallis DS0000009008.V349653.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cornwallis Address Trewidden Road St Ives Cornwall TR26 2BX 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) 01736 796856 01736 797143 cornwalliscare@btconnect.com Cornwallis Care Services Limited Post Vacant Care Home 51 Category(ies) of Dementia - over 65 years of age (51), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (51) Cornwallis DS0000009008.V349653.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd May 2007 Brief Description of the Service: 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. Residents’ 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. The upstairs conservatory has been repaired and refurbished and can be used by the residents. All rooms have call bells and assisted bathing facilities are provided. The garden area is secure and 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 supplied to enquirers on request. A copy of most recent inspection report is available in the home. Fees range from £467.85 to £565 per week according to the manager, who supplied this information during this inspection. Additional charges are made in respect of private healthcare provision, hairdressing and personal items such as newspapers, confectionary and toiletries. Cornwallis DS0000009008.V349653.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors visited Cornwallis Nursing Home on the 02 November 2007. They spent six and three quarter hours at the home. This was an unannounced visit. The purpose of the inspection was to undertake a statutory inspection and to gain an update on the progress of compliance to the requirements identified at the last key inspection on 23 May 2007. All of the key standards were inspected. On the day of inspection 31 residents were living in the home. The methods used to undertake the inspection were to meet with residents, staff, relatives and the management team to gain their views on the services offered by Cornwallis Nursing Home. Records, policies and procedures were examined and the inspectors toured the building. This report summarises the findings of this inspection and evidence gathered from the inspection record and Annual Quality Assurance Assessment document submitted by the manager. There have been further management changes at the home since the last inspection. The current manager has been in post since August 2007 and has applied to be registered with the Commission for Social Care Inspection. What the service does well: A senior member of staff undertakes an assessment of resident’s needs prior to their admission to the home. Other relevant documentation is also obtained from organisations such as the department of adult social care and the healthcare trust. The people using the service have an individual care plan that is generally reviewed each month. There is a suitable system for the administration of medicines. The people using the service appear clean, dressed well and appropriately and they receive suitable portions of nutritious food. A doctor visits the home each week and the home liaises with other healthcare professionals as needed. The home has suitable equipment for moving and handling and pressure relieving purposes that is serviced regularly. Hospital style beds are available if required. Staff appear to be kind and caring and they interact well with the people using the service. They all appear to respect the people using the service. One relative spoke very highly of the care provided and said she has got to know the staff who are dedicated to the residents. There are suitable policies in place for complaints and dealing with abuse. Cornwallis DS0000009008.V349653.R01.S.doc Version 5.2 Page 6 The home is warm and clean with no unpleasant odours, it is well maintained and generally well decorated. The grounds are tidy with an area for the residents that has sturdy garden furniture. What has improved since the last inspection? What they could do better: Although there has been an improvement in the care planning arrangements more detail is required to ensure staff are fully informed of the care to be provided. Individualised risk assessments are needed for those requiring restraint such as cot-sides or other special requirements. Staff need to ensure best practice is used as well as focussing on resident’s safety. The care plans need to include information regarding the person’s previous life history and interests. The medication system in the home needs some improvement to ensure that: Cornwallis DS0000009008.V349653.R01.S.doc Version 5.2 Page 7 • • handwritten details on the charts are witnessed and signed by two members of staff The medicines fridge temperature is monitored and the temperature recorded regularly Improvements to daily life and social activities need to continue to provide stimulation and provide for individual preferences. Residents need to be offered more choices on how to live their daily lives. All staff must receive adult protection training to ensure they are aware of procedures and to safeguard residents. Other training must be provided to ensure that statutory requirements are met and that staff have the knowledge and skills to perform their work. The lack of fire and moving and handling training is a concern. The training policy must be reviewed. Also the content and appropriateness of in house training looked into. The bathing facilities require reviewing to ensure they are suitable for elderly frail, this has been discussed and ideas put forward according to the manager and staff. Recruitment of staff must be equal for everyone with all checks undertaken irrespective of whether they have worked at the home before. People with criminal convictions should be risk assessed to ensure their suitability for working with a vulnerable client group, references must also be obtained from previous employers. The policy for managing resident’s monies must be detailed and specify exactly what is expected to inform and direct staff. 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. Cornwallis DS0000009008.V349653.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cornwallis DS0000009008.V349653.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (6 is N/A) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has statement of purpose that needs a few additions for it to comply with schedule 1. There have been no admissions since the last inspection when the assessment process was satisfactory. EVIDENCE: The home has updated the statement of purpose since the last inspection and a copy was given to the Inspector. There are a few additions to be made and the manager said she would address these. The manager stated that there have been no new people admitted since the last inspection so the assessment documentation is the same as before. This area was not examined at this inspection. The last inspection showed that a senior member of staff assessed residents before admission was arranged. Copies of assessments completed by the healthcare trust or department of adult social care were also obtained. Cornwallis DS0000009008.V349653.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All residents have a care plan; these would benefit from being more detailed, kept up to date and a brief social history for each individual included to ensure personalised care is provided. There is a suitable system in place for dealing with resident’s medicines some improvements were discussed with the manager to safeguard residents further. Staff do their best to treat residents with privacy and respect to ensure their rights as citizens are maintained. EVIDENCE: Each person accommodated has a written care plan. Two care plans were looked at in depth and were reasonably well detailed. However there are some care issues that have not been included in the individualised plans, for example it stated in the daily records for one resident ‘ pressure area care given’ and there were separate wound records but there was no specific care plan. Another person has a very dry mouth but there is no plan for oral care or fluid intake, for example. Care plans are reviewed but not always updated, one man no longer goes to the lounge but his care plan implies that he does. Fluid Cornwallis DS0000009008.V349653.R01.S.doc Version 5.2 Page 11 charts and turning charts are used but need to be completed in detail and columns included for totalling fluids. Life histories are gradually being compiled for residents and the manager has stated in the Annual Quality Assurance Assessment (AQAA) that this is an area to be improved. As stated in the last inspection report generic risk assessments are included with the care plans but they still need to be expanded to include specific risk assessments for individual residents, for example, those needing restraint such as cot-sides and those needing to be nursed on a mattress on the floor. The resident’s representative and any other professional such as the GP or care manager should be involved in the assessing and consenting for the use of restraint. A GP visits the home every week and staff said that community specialist nurses are involved when required. This was evidenced in the records. One nurse acts as a link for tissue viability. Continence assessments have been completed and one care assistant is responsible for the ordering of pads for the residents. Some training has commenced in respect of the Liverpool Care Pathway and Gold Standard Framework for palliative care provision. Pressure relieving and moving and handling equipment is in use and hospital style beds are available. Individual records regarding wound care are maintained the record of the incidence of pressure sores was not found during the inspection. Two suction machines are kept for emergency use but no checks were being made to ensure they are in working order. One had a flat battery and the other a low battery, neither were being charged. The manager rectified the situation during the inspection. Most of the residents were unable to express their views to the inspectors. One relative spoke highly of the care provided for her husband and that the purchase of a special chair has helped him tremendously. Staff were observed to interact well with residents and spent time talking with them and walking around with them. The medicines policy is suitable, however it is still very generic and long, it does not state simply what the home does therefore it is not directive for staff. This was discussed with the new manager who will review the policy further. The nurse did not know where to find the The Royal Pharmaceutical Guidelines for care homes. A monitored dose system is in use and medicines are only administered by registered nurses. The medicine administration and disposal records were satisfactory. There is a photograph of each resident with their medicine records for identification purposes. All hand written orders on the medicine charts must be witnessed and two signatures recorded; this has been notified in previous reports, the new manager agreed to ensure this was done. Cornwallis DS0000009008.V349653.R01.S.doc Version 5.2 Page 12 There was no sharing of medicines. The home does not have anyone needing prescribed oxygen at present and none is stored in the home. There is an approved list of homely remedies signed by a GP and a suitable policy in place. The list is dated February 2006 and is signed by a doctor who has retired. The manager agreed to get a list signed by the current GP who visits the home. The storage of medicines including controlled drugs is satisfactory. There is a medicines fridge but the temperature is not being monitored; the nurse agreed to ensure that this is done. The manager said that all care staff receive some medicines training during induction to the home. The nurse stated that peer assessment of medicine rounds takes place annually. The rounds observed at lunchtime were satisfactory. Most residents spend their time in one of the two lounges, they can move between the two lounges if they wish. Residents can spend time in their bedrooms but this tends to be when they are unwell. Some residents can lock their bedroom doors. Staff were observed knocking on doors before entering and resident’s privacy was maintained. Staff were observed to be respectful of individual residents. Cornwallis DS0000009008.V349653.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Routines, opportunities for stimulation and activities are non institutional but people would benefit if given the chance to participate in more structured activities. They can have their own belongings with them and if able choose how they spend their time, contact with family and friends is encouraged. They benefit from the nutritious food provided and assistance is given appropriately. EVIDENCE: A person has been employed to co-ordinate activities across the three homes and has marketing responsibilities as well. There are some records, on individual daily interaction sheets, of activities undertaken, entertainers visits, one to one chats and visits by relatives. The co-ordinator has started to compile individual details of hobbies and preferred activities. Trips out have been organised, a trip to see the Christmas lights has been booked. There was a Harvest Fare in September and money raised will go towards future activities. Music was playing in the lounges during the inspection and some residents joined in a spontaneous singsong in the afternoon. The management acknowledge that this is an area for improvement. The visitors’ book shows that some residents have regular visitors. The inspector spoke to the wife of one resident who was very positive about the Cornwallis DS0000009008.V349653.R01.S.doc Version 5.2 Page 14 support offered to her husband. She said she is happy with the care provided and that staff are very kind and caring. She is able to visit at any time and can stay as long as she likes. Visitors usually meet with residents either in one of the lounges or in residents’ bedrooms. People were still getting up at ten o’clock, which implies that daily routines are flexible. There are choices on the menu. It was evident residents are able to bring personal possessions into the home, for example, people had some small items of furniture, photographs and other belongings in their bedrooms. The daily records indicate that some people choose how to spend their time and that independence is encouraged. Lunch was served at midday in the two lounges. Residents were encouraged to have their meal at the table but most had a small table at their armchair. Residents appeared to enjoy the meal and assistance provided by staff was good. One carer reported to the nurse on the amount of food eaten by one resident. The new menus include a choice and cooked breakfast is on offer. The meals on offer are written on white boards in the lounges. Cornwallis DS0000009008.V349653.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has suitable complaints and adult protection policies. Further staff training is required in respect of abuse and restraint so that all staff are aware of procedures and how to safeguard the residents. EVIDENCE: There is a suitable complaints policy in the home that is available to staff and is included in the statement of purpose. There have been no complaints since the last inspection. Thank you letters and cards are held in a file. The manager said she would record any complaints received. There is an appropriate adult protection policy and the home has a copy of the local authority procedures. Some staff have undertaken the ‘No Secrets’ training provided by the Cornwall County Council and some have attended internal training. Eight out of thirteen staff files sampled included a certificate for this training. The home’s records show that 50 of staff have attended. Some staff confirmed that they have attended the training and found it very interesting. There is a whistle blowing policy in place. The current CSCI contact details are included in the policies. Practice in the use of bed rails, mattresses on the floor, recliner chairs and so on is aimed at the safety of the resident primarily. However any kind of restraint must be fully risk assessed and documented to avoid it’s use if possible. (see standard 7) Cornwallis DS0000009008.V349653.R01.S.doc Version 5.2 Page 16 Recent anonymous allegations of financial irregularities in respect of resident’s monies have been investigated as part of this inspection. There do not appear to be any issues to uphold at the present time. The Nursing and Midwifery Council are still investigating an alleged POVA incident, regarding a nurse in March 2005. One ex-member of staff has been referred for inclusion on the POVA register following an incident that occurred in October 2005. Police investigations continue. Cornwallis DS0000009008.V349653.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Cornwallis is a suitable facility for the resident group accommodated the building is clean, free from unpleasant odours and systems are in place to prevent the spread of infection. A more varied colour scheme would enhance the appearance and benefit residents with dementia. Improvements must be made to ensure there are appropriate bathing and toilet facilities for people who are frail and disabled. EVIDENCE: The building was inspected and found to be clean and free from offensive odours. There are two large lounge / dining areas that have been pleasantly decorated. The bedrooms are well decorated and a refurbishment programme is underway to make these more individualised and to move away from all white paint. Many of the bathrooms, toilet facilities and corridors are still painted white. It is important, both therapeutically and aesthetically, if there is more variation in the colour scheme. The operations director said that they Cornwallis DS0000009008.V349653.R01.S.doc Version 5.2 Page 18 have researched appropriate colour schemes for people with dementia. The manager said their plans include brighter colours to enable identification of rooms and so on. The reception areas have been tastefully refurbished and the conservatory is now free from leaks. It is a shame that the sofa covers have been splattered with what looks like bleach and one cushion cover has faded probably due to washing. There were no residents occupying the conservatory during the inspection. The two sluice facilities have been reinstated since the last inspection. Toilet and bathroom facilities still need improvement. Currently assisted bath facilities are very limited. There is a bath chair on several of the baths but baths are domestic in type, and not appropriate for those who are very frail or have a physical disability. The registered provider must provide more appropriate bathroom facilities particularly considering the type of residents the home accommodates. The manager said she is hopeful that a wet room facility will be included soon. The manager stated that the high cupboard in one resident’s room that appeared to be used for the storage of the home’s records has been cleared and the records are temporarily stored in an empty bedroom. Cornwallis DS0000009008.V349653.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are sufficient qualified, competent staff to meet the residents’ needs. Recruitment procedures have improved however staff training needs significant improvement to meet legal requirements. EVIDENCE: The manager stated that there are two vacancies for care staff. She said there are sufficient staff, a Registered Mental Nurse on duty for around 90 of the time, at all other times there are competent Registered General Nurses. She was advised to assess their competency to be in charge of this client group and to have records on file. Care staff work 12-hour shifts, i.e. 0800 to 2000 and 2000 to 0800. The manager told us that by day there are usually 5 or 6 carers and 2 nurses and by night there are usually 2 or 3 carers and 1 nurse. There appeared to be sufficient staff on duty. The files of the thirteen staff on duty on the day of the inspection, including night staff, were inspected. The files were generally satisfactory with a completed application form that includes work history and medical declaration, proof of identification, two written references and a copy of a Criminal Records Bureau check (CRB) / Protection of Vulnerable Adults check (POVA) disclosure. There were three individuals’ records discussed with the manager and recommendations made to: Cornwallis DS0000009008.V349653.R01.S.doc Version 5.2 Page 20 • • • ensure all staff are recruited equally and checks are made even if the person has left and returned to work at the home again after a short period of time. ensure that references are always taken up from previous employers risk assess people with criminal records and to evidence that discussion has taken place. The manager was advised to check the rehabilitation of offenders legislation. Staff have the opportunity to complete a National Vocational Qualification (NVQ) in care. The AQAA states that 47 of care staff are qualified to at least NVQ level 2 in care and there was evidence in the files to show that people have NVQ qualifications or are working towards them. The files for thirteen staff were examined along with training records. A large amount of staff training has been delivered internally and there is a training file that shows who has attended individual sessions. • • • • • Fire training has been lacking, twenty out of forty staff have no record of any fire training and others are due for updating. Most care staff appear to have undertaken food hygiene training but only six of the thirteen sampled have certificates on file. All staff handling food must have this training. Four staff, of the thirteen have received first aid training, three to appointed person level, there are also a nurses on duty at all times. Some infection control training has been undertaken as part of a health and safety course and some separate training has been completed internally. The home’s records show approximately 60 of staff have done this. Six out of the thirteen sampled have done some moving and handling training but only one person in the past year. The home’s records show that only six out of forty have a valid certificate. The manager stated that moving and handling training is taking place on 05 November 2007. Eight of the thirteen sampled have done dementia training and the homes records show that 50-70 of staff have done this. Seven of the thirteen sampled have done challenging behaviour training, 35-50 according to the home’s records. There has been some basic medicines training as part of the health and safety training. There was no evidence as to what is included. New staff have an induction checklist, which is completed and signed. • • • • There is no evidence of an ongoing training and development programme. The lack of fire and moving and handling training is of particular concern and could put residents at risk. The training policy is very basic and has not been reviewed since December 2006. Cornwallis DS0000009008.V349653.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. When the current management arrangements have stabilised the home should be run more effectively. Quality assurance and health and safety systems have improved immensely to ensure that continuous improvement is strived for and that people living in the home are safe. A review of the policy and procedures for managing resident’s monies will put further safeguards in place. EVIDENCE: There is a new manager at the home who has applied to the Commission for registration. Her application has been returned as CRB disclosure to be applied for. She is a Registered General Nurse with some experience of working with people with dementia. She has achieved the Registered Managers Award and has previously held a post as registered manager. She has been working at the home since August 2007 and staff said she has taken on a huge task but is Cornwallis DS0000009008.V349653.R01.S.doc Version 5.2 Page 22 settling in well. Staff also said she has a quiet approach but is very supportive towards them and the residents. There is a quality assurance policy in place but practice does not fully reflect the policy. Resident / family meetings are held, the last was in September 2007, minutes are kept and an action plan has been drawn up. A survey was undertaken with a good response rate. The results were positive about the care and services received but suggest that social and leisure events could be improved. It is recommended that an annual development plan be produced. The operations director undertakes regular monthly reports in line with regulation 26. We audited all of the home’s accounts in respect of resident’s monies and checked the arrangements for safekeeping. There is an adequate system in place. There is a policy in place that requires reviewing to detail the homes specific procedures in respect of resident’s monies, for example who hold the keys to the safe and the exact system for the record keeping and so on. The resident’s account is interest bearing and should be reviewed to ensure that interest is proportionately paid to each resident. Personal money is held for residents in separate pockets in the safe. There is an audit sheet for each resident and two people sign all transactions. A receipt is kept for all purchases but no longer numbered the manager was advised to reinstate the number coding system. There is satisfactory evidence that appropriate health and safety precautions are in place. The accident records were inspected and nothing untoward found, the home has relatively few accidents. Machinery and equipment service checks are undertaken regularly. Certificates show that everything apart from one standaid is up to date. The manager said she would ensure this item is not used and is serviced as soon as possible. Fire safety equipment is checked and the records are up to date. Fly screens have been purchased for the kitchen; the screens for the external door have yet to be fitted. Statutory training has taken place but does not meet the legal requirements in all areas this is detailed in the staffing section of this report. Cornwallis DS0000009008.V349653.R01.S.doc Version 5.2 Page 23 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X 1 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 X X 3 Cornwallis DS0000009008.V349653.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15, 17.1(a) Sch 3 Requirement All people using the service must have a detailed care plan that is kept up to date, includes risk assessments relevant to them and a social history. This will ensure person centred care is offered to meet their needs. 2nd notification Timescale for action 14/01/08 2 OP19 16, 23 The registered provider must 14/01/08 ensure that suitable specialist bathing and showering facilities, are provided. This will ensure the needs of elderly frail people are met The manager must ensure that 02/11/07 equal recruitment procedures are followed for every prospective employee. This will ensure equal opportunities and safeguard residents and staff. The manager must review the 14/01/08 training policy and expand it to state what specific training individual staff will receive and when. This will ensure staff know what is expected of them DS0000009008.V349653.R01.S.doc Version 5.2 Page 25 3 OP29 19 Sch 4 4 OP30 18, 19 Cornwallis 3rd Notification 5 OP30 OP18 18 13 (6) The manager must ensure that all staff receive training appropriate to their roles, including induction, abuse and statutory training that complies with legal requirements. This will ensure that staff have the knowledge and skills to care for and safeguard the people using the service. 2nd Notification. The home’s policies must detail the arrangements for the safekeeping of resident’s monies and valuables. This will inform and direct staff 17/12/07 6 OP35 16 (2) (l) Sch 4 (9) 17/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 Refer to Standard OP9 OP19 OP29 OP29 OP30 OP33 Good Practice Recommendations The medicines policy should be reviewed to state concisely what is expected of staff The registered provider should redecorate corridors, bedrooms and bathrooms to create a more diverse colour scheme. A risk assessment should be undertaken for people with a criminal record prior to employment to ensure the person is suitable for employment The registered person should always obtain references from a persons previous employer to ensure the person is suitable for employment The current internal training courses should be reviewed to ensure their content and methods of teaching are suitable to meet the needs of residents, staff and the service. An annual development plan should be developed to indicate what the home intends to improve over the next year DS0000009008.V349653.R01.S.doc Version 5.2 Page 26 Cornwallis 7 OP36 The registered person should ensure that care staff receive formal staff supervision at least six times a year- as outlined in National Minimum Standard 36 Cornwallis DS0000009008.V349653.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Cornwallis DS0000009008.V349653.R01.S.doc Version 5.2 Page 28 - 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!