Inspection on 23/05/07 for Cornwallis

This inspection was carried out on 23rd May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 02/11/07

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 23rd and 24May 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.V336563.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.V336563.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 Cornwallis Care Services Limited Mrs Sherran Thompson 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.V336563.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd May 2006 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. Resident’s 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 conservatory has been out of use for some time due to repairs being needed. 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 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.V336563.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 23 and 24 May 2007. They spent fourteen and a half 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 2006 and updated in the random inspection report dated 23 November 2006. All of the key standards were inspected. On the day of inspection 34 residents were living in the home, 2 of these were receiving respite care. The methods used to undertake the inspection were to meet with a number of 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. One of the inspectors undertook a two-hour observation of care practices in one of the lounges of the home. This report summarises the findings of this inspection. There have been management changes at the home since the last inspection. The registered manager has been suspended from work and has declared she is not responsible for the management of the home anymore, there is an acting manager now in post. 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. A doctor visits the home each week and the home liaises with other healthcare professionals when needed. Residents have an individual care plan that is reviewed regularly. Residents appear to have their personal care needs addressed appropriately for instance they appear clean, dressed well and appropriately and they receive suitable portions of nutritious food. Staff appear to be caring and show compassion and concern regarding resident’s needs. 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 with sturdy garden furniture. Cornwallis DS0000009008.V336563.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: This key inspection has produced a significant number of statutory requirements, some of which are re-notified. Two immediate requirements were made during the inspection. These are legal requirements, which must be implemented by law. An improvement plan will be requested for this home. More detail is required in the care plans 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. There needs to be a photograph of each resident on care plans and medication records, as many residents have limited cognitive skills and some are now unable to speak clearly. The medication system in the home needs some improvement to ensure that: • prescribed medicines are only administered to that person • handwritten details on the charts are witnessed and signed by two members of staff • a photograph of the resident is kept on the individuals medicine chart • the home’s method for washing the medicine pots is clearly stated in the medicines policy • formal basic medicines training must be included in the induction programme for care staff Improvement needs to occur regarding the arrangements for residents’ daily life and social activities. At present there is little stimulation to help individuals maintain a sense of their own personhood, or attempts by staff to respect people’s individuality. Residents need to be offered more choices on how to live their daily lives. Staff are kind and caring but need to talk to residents and Cornwallis DS0000009008.V336563.R01.S.doc Version 5.2 Page 7 explain what they are about to do, for example, from observation no attempt was made to inform residents what or when their meal would be or for them to be offered any choice of food available. The manager said the menus and mealtimes are under review, which should improve choices. The adult protection policy needs to include the contact details for the Department of Adult Social Care and the Commission for Social Care Inspection. The management team must be fully aware of the local authority procedures and reporting systems. Redecoration and refurbishment has been taking place however it does not appear that any advice has been sought regarding the needs of people with dementia. This should be sought regarding the redecoration of other rooms. There are insufficient specialist bathing facilities and this must also be reviewed. Although the registered persons do need to ensure residents are physically safe and their privacy respected some of the bedroom, bathroom and staff toilet doors do not need to be locked. The manager stated that this was done when there were several residents who would wander around the home and go into rooms at random. Some doors were unlocked during the inspection. Although the conservatory has been decorated with furniture provided the leaking roof must be repaired to enable residents to use this lovely room. The manager said she would review a high cupboard in one resident’s room that appeared to be used for the storage of the home’s records. The home must reinstate the sluicing facilities that have been removed for waste disposal and infection control purposes. Staff awaiting CRB disclosure must be adequately supervised and the inspectors made an immediate requirement that the registered provider inform the Commission in writing of these arrangements. The inspectors raised concerns regarding an undeclared criminal conviction on a persons CRB disclosure. An immediate requirement was issued for the registered provider to investigate this and inform the Commission in writing of the action he is taking. The staff training provision, including induction needs to be reviewed with suitable records maintained to evidence individual staff attendance and the content of the training. The training policy must state the specific training that staff need to attend and the frequency of it, this requirement is notified for the second time. Formal staff supervision is also required to ensure staff are supported and know what is expected of them. As the registered manager is no longer working in the home the registered provider must keep the Commission informed of the situation. Cornwallis DS0000009008.V336563.R01.S.doc Version 5.2 Page 8 A copy of the electrical hardwiring test certificate, evidence that the portable electrical appliances have been tested and a copy of an up to date gas safety certificate must be sent to the Commission. Health and safety risk assessments must be dated with evidence that they are reviewed periodically. Suitable fly screens must be fitted to windows and the external door in the kitchen. 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.V336563.R01.S.doc Version 5.2 Page 9 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.V336563.R01.S.doc Version 5.2 Page 10 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): 1 and 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 a suitable statement of purpose that states the new management arrangements; it is however in need of a full review. Residents are only admitted to the home following an assessment of their needs. This ensures care staff have suitable information to meet residents’ needs. Intermediate care is not offered at this service. EVIDENCE: Evidence was provided in the form of records and discussion with the management team. The home has a suitable statement of purpose that includes the new management arrangements. It needs to have more detail regarding Sarah Foulds management experience to show her capability to manage the home. The manager agreed to do this and to review the document as a whole. Cornwallis DS0000009008.V336563.R01.S.doc Version 5.2 Page 11 Several resident files were inspected. Records show that a senior member of staff assesses residents before admission is arranged. Copies of assessments completed by the healthcare trust or department of adult social care were also obtained. These were available for inspection on some residents’ files. Cornwallis DS0000009008.V336563.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is 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 a photograph and brief social history for each individual. This will ensure that staff can identify the resident, for example when medication is administered, and make staff more aware of the residents’ background to maintain their individual personhood. 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. This helps to ensure residents are cared for appropriately and their rights as citizens are maintained. EVIDENCE: Evidence was provided in the form of records, interviews with residents, and discussion with the management team. Several resident files were inspected. Records show that residents have a care plan, and there is evidence that care plans are regularly reviewed. However care plans should include a brief social history so staff know, for example, if Cornwallis DS0000009008.V336563.R01.S.doc Version 5.2 Page 13 the person has family, what there interests are, what their job was and so on. This will help staff to develop relationships, and help to maintain the resident’s personhood. It is important that a photograph is contained on each care plan and on the medication records as many of the residents cannot confirm their names, and staff need to be clear, for example, that they are giving the correct medication to the correct resident. The care plan format has improved although it needs to be more specific and detail exactly what is expected of the care staff. Generic risk assessments are included but these 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 inspector is slightly concerned as to whether the needs of one resident are individualised. The person’s needs appear to be quite different to those of the majority of residents. For example the person’s cognitive skills appear to be at a higher level than many of the other residents in the home. The inspector has asked the manager to check the person’s diagnosis, as recorded in the care plan, is correct. Secondly, the staff need to ensure the person has suitable opportunities for stimulation and recreation. The person concerned, for example, said she would appreciate more opportunity to talk with staff. It may be the person would benefit from having a befriender or possibly living in a less specialist home where there would be more opportunities available for the person. The person does have regular reviews with the mental health team under the ‘Care Plan Approach,’ and this may be one forum to address some of these issues. A GP visits the home every week and the manager said that community specialist nurses are involved when required. This was evidenced in the records. She said the continence assessments have been completed and one care assistant is responsible for the ordering of pads for the residents. Pressure relieving and moving and handling equipment is in use and hospital style beds are available. Individual records regarding wound care are maintained and a record of the incidence of pressure sores has been commenced. The medicines policy is suitable, however it is very generic and long, it does not state simply what the home does therefore it is not very directive for staff. This was discussed with the manager who will review the policy further. A monitored dose system is in use and medicines are only administered by registered nurses. The medicine administration and disposal records were satisfactory. There does need to be 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. Medicines such as lactulose syrup were again seen to be shared among several residents and this was also discussed with the manager; medicines prescribed for an individual resident must not be administered to anyone else. The home does not have anyone needing prescribed oxygen at present and none is Cornwallis DS0000009008.V336563.R01.S.doc Version 5.2 Page 14 stored in the home. There is an approved list of homely remedies signed by a GP and a suitable policy in place. The storage of medicines including controlled drugs is satisfactory. Medicine pots used to be washed in the kitchen, which is the preferred system. A nurse stated that they are now washed in the medicines room. If this is the case a separate bowl and washing up liquid must be provided, the hand washing sink is not appropriate for infection control reasons. The system used must be clearly stated in the medicines policy. The manager said that all care staff receive some medicines training during induction to the home, she agreed to formalise this so that it can be evidenced during inspections. One of the inspector’s completed a two-hour observation of care practices. This focused on observing the interactions of five of the fifteen residents sitting in one of the lounges. Support and care provided for residents is generally to a good standard. Staff were busy and attentive to resident’s needs. The majority of staff interactions were good. For example staff talked with residents when they needed to assist them with something, and staff were respectful. Most residents spend their time in one of the two lounges and residents also move between the two lounges. However a minority of residents do spend time in their bedrooms. Some residents can lock their bedroom doors. Residents said staff always knock on their doors and maintain their privacy. Staff were observed to be respectful of individual residents. Cornwallis DS0000009008.V336563.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is generally adequate. This judgement has been made using available evidence including a visit to this service. Routines, opportunities for stimulation and activities are non institutional and generally adequate. Residents would benefit from having more opportunity to participate in structured activities, and other forms of stimulation such as magazines / newspapers to ensure residents have more opportunities for engagement and stimulation. Visiting arrangements are satisfactory so residents can see their relatives and friends when they wish. Residents are also able to bring their own belongings into the home, and bedrooms appear to be personalised and generally comfortable. Arrangements for mealtimes are satisfactory, the meal served on the day of the inspection looked wholesome and appetising, and residents appear to receive appropriate levels of support. EVIDENCE: Evidence was provided in the form of documentation, records, observation, talking with residents, staff and the management team. Cornwallis DS0000009008.V336563.R01.S.doc Version 5.2 Page 16 As stated in the previous section, one of the inspectors completed a two hour structured observation in one of the two communal lounges. Staff interaction with residents was generally positive throughout the observation. There were limited activities available, but staff did their best to talk with residents, when they had time, and to ensure residents were comfortable. Staff seemed kind and caring. The majority of the time the residents observed tended to be passive to their surroundings i.e. sitting in their chairs, not really interested in their surroundings but responding to what they were asked to do by staff. There was limited interaction between residents. Two of the residents spent a significant period of time asleep during the observation. Staff were engaged in tasks with residents throughout the observation, for example serving teas, helping people with personal care, serving the lunch and assisting residents with their meals. One care assistant had a game of cards with one of the residents, and the others sat and had a chat with residents between the tasks they had to do. There was only limited opportunity for the staff on duty to engage with residents, given the staffing available. Staff acknowledged they would like to do more with residents, and said they did what they could given the time they had. As stated in the previous section, at least one resident would benefit from more stimulation and activities tailored to that person’s individual needs. When not engaged with staff some residents managed to provide a certain amount of occupation for themselves, for example, walking around, watching the TV and so on. Residents, on the whole, did not seem to be in any distress, and staff were supportive when this was the case. It would be beneficial if there were some additional opportunities for residents’ entertainment- for example the provision of newspapers, magazines, picture books and so on. The manager stated that she is looking to employ an activities co-ordinator she said that in the interim care staff have a list of activities that they can choose from to provide daily activities. She said one carer has an art degree and she will utilise his skills, a garden party is being arranged for the Queen’s birthday and she is hoping to provide pet therapy. She said that records have been maintained for activities but these could not be found during the inspection. The visitors’ book shows that some residents have regular visitors. The inspectors were able to speak to the relative of one resident who was very positive about the support offered to their relative. Visitors usually meet with residents either in one of the lounges or in residents’ bedrooms. Visitors are able to visit their friends or relatives at any time. The manager said that a religious minister does visit a few residents but there are no regular services or communion at present. This would be beneficial if residents would like to have the opportunity for religious observation. Cornwallis DS0000009008.V336563.R01.S.doc Version 5.2 Page 17 Suitable arrangements are in place regarding the management of resident’s monies; no residents control their own money at present. This subject is covered fully in the management section of this report. It was evident residents are able to bring personal possessions into the home, for example, people had some small items of furniture, and other small items in their bedrooms. Lunch was served at midday. Residents were encouraged to have their meal at the table, and were given support to go to the toilet beforehand, move to the dining area and so on. The meal- Chicken Chasseur- looked appetising and residents appeared to enjoy the meal. Support provided by staff was good, and the meal was a relaxed occasion. A minority of residents had their meals in their chairs because they had difficulty in getting to the table. This appeared to be appropriate. The only suggestions for improvement regarding this standard would be for staff to inform residents when it would be lunchtime, and what the meal is before it is served. There did not appear to be any choice of meal – or at least a choice was not offered when the meal was served. The manager said there are alternatives to the set menu but not a choice as such. She is looking to change the menus and is going to involve the residents in the process. Cornwallis DS0000009008.V336563.R01.S.doc Version 5.2 Page 18 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 a complaints procedure that states that complaints will be listened to and acted upon. Records of complaints must be maintained. Arrangements are in place for the protection of residents from abuse, however further staff training is required and managers need to be fully aware of the local inter agency procedures. EVIDENCE: Evidence was provided in the form of CSCI records, documentation and talking with staff and the management team. There is a suitable complaints policy in the home, the CSCI contact details require updating. The policy is available to staff and is included in the statement of purpose. There was no evidence of a complaint records file although records have been seen in the past; the manager will ensure that records are kept and will endeavour to find the file. There are a number of thank you letters and cards held in a file. The complaint mentioned in the last key inspection report was dealt with by the home however the family were not fully satisfied. They also said they never received a copy of the home’s complaint policy. Cornwallis DS0000009008.V336563.R01.S.doc Version 5.2 Page 19 Concerns were raised to the home and the Commission regarding the moving and handling of an individual resident, this was dealt with by the registered manager. There is an appropriate adult protection policy and the home has a copy of the local authority procedures. The policy needs to include the contact details for the Department of Adult Social Care and the Commission for Social Care Inspection; the manager agreed to get this done. Some staff have received the ‘No Secrets’ training. The manager was not fully aware of the procedures. There is a whistle blowing policy in place. 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. A relative reported an alleged abuse incident; the police and the department of adult social care were satisfied this was an accident and not abuse. A member of staff struck a resident and the department of adult social care undertook an investigation. The outcome was that the member of staff was probably defending himself and this was an accident. The member of staff has left the home and as far as we are aware he is no longer working as a nurse. As mentioned under standard 7 risk assessments must be undertaken for the use of equipment such as cot-sides and nursing residents on mattresses on the floor and so on to ensure appropriate use rather than focusing on keeping people safe. The management must ensure that suitable employment checks are received prior to staff working in the home. These issues have been raised with the manager and requirements notified. This area is covered under standard 29 of this report. Cornwallis DS0000009008.V336563.R01.S.doc Version 5.2 Page 20 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, 20, 21, 22, 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 and the building is clean and generally free from unpleasant odours. A more varied colour scheme would enhance the appearance and benefit residents with dementia. It is important the roof of the conservatory is fixed, as the use of this pleasant facility would benefit residents considerably. Improved bathing facilities must be provided to ensure there are appropriate bathing and toilet facilities for people who are frail and disabled. The locking of some bathroom and toilet doors must be reviewed, as this is an unnecessary restriction on the residents living in the home. Sluice facilities must be provided, as these are essential for infection control and hygiene purposes. EVIDENCE: Evidence was provided in the form of documentation, observation, inspection of the building, talking with staff and the management team. Cornwallis DS0000009008.V336563.R01.S.doc Version 5.2 Page 21 The building was inspected. It is clean, reasonably well maintained and generally free from any unpleasant odours. There are two large lounge / dining areas. One of the lounges has recently been refurbished but both lounges are pleasantly decorated. Most residents have their own bedrooms that are generally well decorated, although a refurbishment programme is underway to make these more individualised. Many of the bedrooms, bathroom / toilet facilities and corridors are painted white. It is important, both therapeutically and aesthetically, if there is more variation in the colour scheme. Toilet and bathroom facilities 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. More appropriate facilities would include at least one ‘Parker’ type bath, and also possibly a ‘wet room’. A requirement was made regarding this issue in the previous key inspection report dated 22nd May 2006, and this is subsequently renotified. The sluice facilities which were previously available have been removed. These must be reinstated as a matter of priority. The registered provider needs to seek advice about the care needs of people with dementia regarding any subsequent redecoration and refurbishment. There are many publications available which would be useful for the registered provider to look at: Dementia Voice: http:/www.dementia-voice.org.uk/index.htm or the Dementia Development Centre Stirling: http:/www.dementia.stir.ac.uk/publications/design_housing.htm Other organisations may be able to offer assistance, or sell publications, which will offer advice regarding suitable design for homes for people with dementia. Some of the bathrooms and toilets were locked during the inspection. The registered provider needs to consider whether this is really necessary, as it creates unnecessary restriction on people being able to use these facilities. The manager said she would risk assess the use of locks in the home as there are few residents that wander; the staff toilets and some of the downstairs rooms were unlocked during the inspection. Cleanliness in one of the toilets needs some improvement i.e. the incontinence pad bin needs to be changed more regularly as the room smelt unpleasant. The manager said she would review a high cupboard in one resident’s room that appeared to be used for the storage of the home’s records. Cornwallis DS0000009008.V336563.R01.S.doc Version 5.2 Page 22 The home has a large and pleasant conservatory that has lovely views of the sea, and the town of St Ives. The conservatory has recently been redecorated with new furniture purchased, however it has been out of use for over a year due to a leaking roof which needs to be fixed as soon as possible so residents can benefit from this pleasant facility. Cornwallis DS0000009008.V336563.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels appear to be satisfactory so residents can be assured they will receive appropriate levels of support from staff. There is a suitable number of care staff trained to at least NVQ level 2 in care. Recruitment procedures and staff training need significant improvement so these areas meet legal requirements. EVIDENCE: Evidence was provided in the form of records, observation of practice, and discussion with residents, staff and the management team. Rotas show satisfactory staffing levels are available to residents. Generally there are six care staff and one or two nursing staff from 0800 to 2000 hours. There are three care staff and one nurse overnight all of whom are awake. There is a vacancy for a full time night nurse. Auxiliary staff such as cooks, cleaners and maintenance staff are also provided. The manager and staff spoken with felt the staffing levels were appropriate. A key-worker system is in place and the manager said the skill mix is good. Staff support was observed to be professional and competent and residents said staff were supportive, friendly and caring. Staff said there have been a lot of changes recently and it has been difficult to keep up with them, some admitted Cornwallis DS0000009008.V336563.R01.S.doc Version 5.2 Page 24 they were close to leaving. All staff said they enjoy the work and feel the residents are well looked after. Staff records for ten members of staff were inspected and these were variable in quality. Most records inspected had a completed application form, two written references and a copy of a Criminal Records Bureau check (CRB) / Protection of Vulnerable Adults check (POVA) disclosure. However the inspector was concerned about the checks completed for some staff- most of whom commenced employment from January 2007: • Two of the staff only had one written reference. One of these people had received only one poor reference from a previous employer. • Five staff were working without a satisfactory CRB check. Four of these people had a check applied for but not returned. There did not appear to be any form of supervision of these staff in place, as required in the CRB guidance and care homes regulations. The fifth person had a disclosure returned but it contained a recent criminal conviction, which the person had failed to declare on their application form. Three of these people appeared to be working without a POVA First check, let alone a CRB check. • There were no records of staff induction available for inspection for six staff. Two of these commenced employment in 2006, two commenced in January 2007, and two commenced employment in April and May 2007. • There were records that four people last had supervision in March 2007, but no records were available for the other six staff. The registered provider must ensure satisfactory staff records are kept and available for inspection. Two immediate requirements were made as a consequence of the evidence inspected: • Firstly, that suitable employment checks are completed regarding potential employees before they commence employment, for example two satisfactory references and a POVA First check. The POVA First check must be followed up by a CRB check and the person must be supervised until this check is returned. Secondly, the registered provider must investigate the suitability of the person employed who has an undeclared criminal conviction on their CRB check. The registered provider has been asked to confirm in writing to the commission the action taken regarding these issues, including what supervision arrangements will be put in place, for staff without satisfactory POVA /CRB checks. • The inspector checked the employment record of the registered nurse on duty. The photocopy of the nurse’s registration (PIN) had expired. The nurse may still be registered, but there must be suitable documentary evidence this is the case. The registered provider must ensure that records of any registered nurse PIN numbers are current, and liaise with the Nurses and Midwifery Council that Cornwallis DS0000009008.V336563.R01.S.doc Version 5.2 Page 25 any nurse employed is satisfactorily registered with them. There must be evidence these checks have been completed. At the last key inspection in May 2006, a statutory requirement was issued for the registered provider to develop a training policy outlining what training care staff would receive. This has not been complied with and is subsequently renotified. Training records were inspected for the ten staff. By law care staff must receive the following training: • Regular fire training. • Infection control training. • Moving and handling training – if any moving and handling of objects or residents is required. • First Aid training- (i.e. there must be at least one trained ‘appointed’ first aider on duty at any one time.) • Food handling training- if food is handled. • Medication training- if medication is handled. Records showed that six staff had last received fire training between June 2006 and October 2006. There was a lack of records for the other staff. Four of the staff had received training regarding infection control between July 2005 and July 2006. Four of the staff had received moving and handling training between February 2006 and August 2006. There is no record of staff receiving any first aid training, although there is always a registered nurse on duty. Five of the staff have received food handling training between August 2005 and January 2007. There is no record of staff receiving any training regarding the handling of medication, although there is always a registered nurse on duty. Staff working in a care home providing care for people with mental disorder and dementia, need to have training in dementia and mental health awareness, so they can appropriately support the resident group. Records show four of the ten staff, for whom records were inspected, had training in dementia. There does not appear to have been any training in mental health for example regarding different mental health diagnoses people may have, or how to work with these people. Records show some staff have also received training in recognising and preventing abuse, dying and bereavement, health and safety, COSHH, challenging behaviour. The inspector was concerned that senior staff conduct all training internally, and no external trainers are currently used. While there is no legal reason why this should not be conducted as such, the trainer must be appropriately experienced and qualified in the area they are training. Training should also not only consist of the trainee reading the relevant policy; for example there should be opportunity for instruction, group discussion, and exercises. Training sessions should be of a suitable length so the area covered can be completed in some depth. From the information provided, there is not satisfactory Cornwallis DS0000009008.V336563.R01.S.doc Version 5.2 Page 26 evidence this is the case. The registered provider needs to review that training provided is satisfactory, and suitable evidence of individual training programmes are available for inspection. Staff have the opportunity to complete a National Vocational Qualification (NVQ) in care. Of the ten care staff files inspected four care staff had a copy of an NVQ certificate available for inspection. The manager stated that 40 of care staff are qualified to at least NVQ level 2 in care and five staff are progressing with the course. Cornwallis DS0000009008.V336563.R01.S.doc Version 5.2 Page 27 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, 36 and 38 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Management arrangements need to be improved so residents can be assured the home is managed effectively. There appears little evidence of any systems to ensure the quality of the service is improved. This is essential to ensure residents receive a good quality service and the registered provider can meet regulatory requirements. Satisfactory systems are in place regarding the management of resident monies. Residents can subsequently be assured that were the registered provider is involved in the management of their monies this is carried out to a satisfactory standard. Improvement in staff supervision arrangements are required so staff receive formal support and guidance regarding their work. Health and safety requirements need improvement so residents can be assured they live in a safe environment. EVIDENCE: Cornwallis DS0000009008.V336563.R01.S.doc Version 5.2 Page 28 Evidence was provided in the form of policies, records, talking with staff and discussion with the management team. The registered provider has suspended the registered manager from the home pending investigation. The registered manager has written to the Commission for Social Care Inspection to state she is no longer responsible for the management of the home. A manager Sarah Foulds has been employed to manage the home until the issues regarding the registered manager have been resolved. The registered provider must keep the Commission updated regarding the situation. The present manager is a Registered Mental Nurse who has some experience as a clinical manager. She said she keeps herself updated by attending relevant study days and reading the nursing press. She said her enrolment on the Registered Managers Award course is imminent. She has an employment handbook and a job description and she said the operations manager has been assisting her with the business aspects of managing the home. A quality assurance policy was inspected which was brief and there is no evidence this has been implemented. For example there is no system to ascertain resident (and other stakeholder) views, although the secretary said that a survey had been done last year, no annual development plan or other systems are in place to assist in bringing about change and improving quality. There is also no evidence the registered provider completes monthly visits to the home, as required by regulation 26 of the Care Homes Regulations 2001. The Operations Director stated he would be undertaking these in future. It is of concern that there has been some decline in standards since the last inspection for example recruitment and training and there has not been satisfactory progress with some of the statutory requirements issued in the previous inspection report. The manager did state that she intends to undertake various audits; she was unsure where previous audit information was kept. She also intends to have regular monthly staff meetings. No resident / representative meetings take place at the moment. There is evidence that staff receive some formal one to one supervision with a senior member of staff. However the last sessions were in March 2007. There are no records of staff supervision for some staff, including four staff that commenced employment in 2007. There is a policy for the safekeeping of resident’s money, which needs to include how much money can be held per person. Pocket money is held for all residents in separate pockets in the safe. There is an audit sheet for each resident and all transactions have two signatures. The records are also checked at random each month by the accounts department. Receipts for all purchases Cornwallis DS0000009008.V336563.R01.S.doc Version 5.2 Page 29 are also kept and numbered. The resident or their representative consents to the home handling their money. The home has a health and safety policy. Health and safety records were inspected. A fire risk assessment is in place. There is a suitable system to test fire alarm call points and emergency lighting. The home has a satisfactory moving and handling policy, and there is evidence hoists are tested. The manager said there is a new contract to service the lift. However no evidence has been produced that the lift has been recently serviced, and a statutory requirement is issued that the lift is serviced (if it has not been) and evidence of this is forwarded to the Commission. There is a policy regarding the prevention of Legionella and a risk assessment is in place regarding this. Other health and safety risk assessments have been completed. However these are not dated, and it is difficult to ascertain if these are periodically reviewed. Therefore evidence of review needs to be available. There is no evidence that portable electrical appliances have been recently tested. A statutory requirement is issued that portable electrical appliances are tested (if they have not been) and evidence of this is forwarded to the Commission. A copy of a letter from a qualified electrician dated 18/12/2006 to the registered provider has been forwarded to the Commission. This states that a check on the electrical ‘hardwire’ circuit has been completed, and although generally satisfactory some remedial work is required. Electrical contractors should also issue any completed test on a specified format, and the registered provider needs to clarify with the contractor why this has not occurred, and obtain the appropriate documentation. Gas appliances were tested on in April 2006, these need to be retested, and an up to date gas safety certificate obtained. Evidence of this must be forwarded to the Commission. Fridge and freezer temperatures are recorded in the kitchen and cleaning rotas are in place signed by the person undertaking the cleaning. The windows and external door were open in the kitchen during the inspection as it was a hot day; suitable fly screens must be fitted to these windows and the door. There is a programme of health and safety training required by law, although improvement is required as highlighted in the previous section of the report. Cornwallis DS0000009008.V336563.R01.S.doc Version 5.2 Page 30 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 2 17 X 18 2 1 2 1 2 X X X 2 STAFFING Standard No Score 27 3 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 2 X 1 Cornwallis DS0000009008.V336563.R01.S.doc Version 5.2 Page 31 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 The registered person shall prepare a written plan as to how the resident’s needs in respect of her / his health and welfare are to be met. (This should be detailed to inform and direct care staff. It should include risk assessments relevant to the individual, a photograph of the resident, and a brief social history) Ensure the care plan of one specific resident outlines that person’s needs, and subsequently the resident has suitable opportunities for recreation and stimulation. Timescale for action 01/08/07 2 OP7 15 01/08/07 3 OP19 16, 23 01/06/08 The registered person shall having regard to the number and needs of the service users ensure that— (a) the physical design and layout of the premises to be used as the care home meet the needs of the service users; The registered provider needs to Cornwallis DS0000009008.V336563.R01.S.doc Version 5.2 Page 32 redecorate corridors, bedrooms and bathrooms etc. to create a more diverse colour scheme. The registered persons should seek advice from e.g. Dementia Voice, regarding appropriate decoration and colour schemes for people with dementia. 4 OP19 OP20 OP21 OP22 16, 23 The registered provider must 01/12/07 ensure the care home is suitable for achieving the aims and objectives set out in the statement of purpose. For example; the registered person shall having regard to the number and needs of the residents ensure that suitable adaptations are made, and such support, equipment and facilities, as may be required are provided, for residents who are old, infirm or physically disabled; (for example specialist bathing facilities such as a ‘parker’ type bath.) The registered persons must, so far as practicable, enable residents to make decisions with respect to the care they are to receive and their health and welfare. They shall so far as practicable take into account their wishes and feelings. For example: • Freedom of movement around the building must be assessed and confinement of residents kept to a minimum. • Residents must be individually risk assessed regarding their ability to use bathroom / toilet facilities, and where necessary suitable support measures put in DS0000009008.V336563.R01.S.doc 5 OP19 OP20 OP21 OP22 12(2)(3) 16(2)(i) 01/08/07 Cornwallis Version 5.2 Page 33 place. The registered persons should seek specialist advice from external professionals regarding alternative strategies to locking bathrooms / toilet doors to prevent access. 6 OP19 OP20 16, 23 The registered person shall 01/08/07 having regard to the number and needs of the residents ensure that— (a) The premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally. (b) There is adequate sitting, recreational and dining space provided separately from the resident’s private accommodation. (For example the conservatory needs to be repaired and made available for residents). The registered provider shall 01/08/07 having regard to the number and needs of the residents ensure that sluicing facilities are provided. The registered person shall not employ a person to work at the care home unless the person is fit to do so. Satisfactory checks must be completed on the person to ascertain this. (For example two written references, a Protection of Vulnerable Adults ‘First’ check, a Criminal Records Bureau check etc. as outlined in Schedule 2 of the Care Homes Regulations 2001). DS0000009008.V336563.R01.S.doc 7 OP21 OP26 23(2)(k) 8 OP29 18. 19 24/05/07 Cornwallis Version 5.2 Page 34 The registered provider must inform the Commission in writing as soon as possible what supervision arrangements will be put in place for staff who do not have a satisfactory CRB disclosure. Immediate Requirement 9 OP29 18. 19 The registered person shall not employ a person to work at the care home unless the person is fit to do so. For example staff must be of integrity and good character. (For example the registered provider must investigate the suitability of the employment of an employee after CSCI raised concerns regarding an undeclared criminal conviction on the persons CRB Disclosure). The registered provider must inform the Commission in writing, as soon as possible, what action will be taken once the investigation is complete. Immediate Requirement 10 OP29 18. 19 The registered person shall not employ a person to work at the care home unless the person is fit to do so. For example staff must be of integrity and good character. (For example the registered provider must ensure that records of any registered nurse PIN numbers are current, and liaise with the Nurses and Midwifery Council that any nurse employed is satisfactorily registered with them.) 01/08/07 24/05/07 Cornwallis DS0000009008.V336563.R01.S.doc Version 5.2 Page 35 11 OP29 18. 19 The registered person shall 01/08/07 ensure that persons employed to work at the care home receive training appropriate to the work they are to perform. This must include structured induction training and suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to such work. The registered person shall ensure that persons working at the care home are appropriately supervised (For example care staff need to receive formal staff supervision at least six times a year- as outlined in National Minimum Standard 36) The registered persons must expand the training policy to state what specific training individual staff will receive and when. Previous deadline of 31/12/06 not met. 2nd Notification. 01/08/07 12 OP29 OP36 18 13 OP30 18, 19 01/08/07 14 OP30 18 The registered person shall: (a) At all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of residents. (b) The persons employed by the registered person to work at the care home receive— (i) Training appropriate to the work they are to perform. (ii) Suitable assistance, DS0000009008.V336563.R01.S.doc 01/12/07 Cornwallis Version 5.2 Page 36 including time off, for the purpose of obtaining further qualifications appropriate to such work. (c) Keep suitable records of training provided for individual staff employed. (For example training must include fire training, infection control, manual handling, mental health awareness, dementia awareness. Where appropriate training must include handling medication, food hygiene and first aid Previous deadline of 31/12/06 not met. 2nd Notification. Review current internal training courses to ensure their content and methods of teaching are suitable to meet the needs of residents, staff and the service. 15 OP31 9 A person shall not manage a care home unless s/he is: (1) Fit to do so. (2) Of integrity and good character. (The registered provider therefore must keep the Commission updated regarding the investigation regarding the fitness of the registered manager). Where the registered provider is an individual, but not in day-today charge of the care home, she or he shall visit the care home in accordance with this regulation, and supply a copy of the report to the Commission. DS0000009008.V336563.R01.S.doc 01/08/07 16 OP31 26 01/08/07 Cornwallis Version 5.2 Page 37 (Previous timescale of 01/12/06 not met 2nd Notification) 17 OP33 24 The registered person shall establish and maintain a system for evaluating the quality of the services provided at the care home The registered person shall ensure that— (a) All parts of the home to which residents have access are so far as reasonably practicable free from hazards to their safety; Unnecessary risks to the health or safety of residents are identified and so far as possible eliminated. The premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally; Equipment provided at the care home for use by residents or persons who work at the care home is maintained in good working order; 01/08/07 18 OP38 13, 23 01/08/07 (b) (c) (d) (For example there must be: (1) Suitable health and safety risk assessments and these must be regularly reviewed. (2) Evidence the lift is regularly serviced. Evidence of this must be forwarded Cornwallis DS0000009008.V336563.R01.S.doc Version 5.2 Page 38 (3) (4) (5) (6) to the commission. Evidence portable electrical appliances are regularly tested. Evidence of this must be forwarded to the commission. Evidence gas appliances are regularly tested. Evidence of this must be forwarded to the commission. A suitable certificate issued by a qualified electrician to state the electrical hardwire circuit has been tested and is safe. ) Appropriate fly screens must be fitted to the windows and external door in the kitchen RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cornwallis DS0000009008.V336563.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection Devon Office Unit D1 Linhay Business Park Ashburton Devon 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. 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