Random inspection report
Care homes for older people
Name: Address: Cornwallis Trewidden Road St Ives Cornwall TR26 2BX one star adequate service 23/10/2008 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Diana Penrose Date: 2 8 0 7 2 0 0 9 Information about the care home
Name of care home: Address: Cornwallis Trewidden Road St Ives Cornwall TR26 2BX 01736796856 01736797143 cornwalliscare@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Cornwallis Care Services Limited care home 51 Number of places (if applicable): Under 65 Over 65 51 51 dementia mental disorder, excluding learning disability or dementia Conditions of registration: Date of last inspection Brief description of the care home 0 0 2 3 1 0 2 0 0 8 Cornwallis Nursing Home is a detached property located above the town of St Ives, Cornwall. It is a three-storey dwelling and is situated at the top of a hill. The home offers nursing care for up to fifty-one elderly residents with a dementia or mental health problem. Residents accommodation is spread over three floors. Private bedrooms are shared or single, with bedrooms on the first floor having en suite provision. There are two communal lounge / dining areas, plus a conservatory, which has sea views. 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 accessible to residents. There are opportunities for socialising and
Care Homes for Older People Page 2 of 11 Brief description of the care home 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 490 to 695 pounds 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. Care Homes for Older People Page 3 of 11 What we found:
Two Inspectors visited the home to ascertain the current management arrangements and to investigate concerns received by the Care Quality Commission. The concerns were in relation to staffing, the lack of a manager and qualified nurses and inexperienced care staff on duty. Recruitment of staff . Assessment of prospective residents, care planning and nutritional assessments. On the morning of the inspection there were thirty three people using the service. There was one Registered General Nurse on duty with five care staff. The nurse said she normally worked at another home owned by the Company so did not know the residents very well. There were catering, laundry and housekeeping staff working in the home. We were told that the Operations Manager was off duty as was the Facilities Manager although they both arrived later in the morning. We were also told that the Registered Mental Nurse (RMN), responsible for coordinating the care of people using the service was working nights. We were shown the duty rota which showed that four qualified nurses are employed and two nurses from other homes owned by the Company have been working at the home. The rota confirmed that the RMN responsible for coordinating the care of people using the service was indeed working nights. The rota showed that there is one nurse on duty at all times. In addition there are generally four or five care staff during the day and two at night. One carer has responsibility for the one to one care of a resident in the mornings and an agency carer is employed to take over from 13.00 - 17.00 hours. A member of staff said there are not enough nurses and it is better when two are on duty. The Operations Manager told us that he has been advertising for nurses but has not been successful. Since this inspection he has informed us that an RMN, who used to work at the home, has been re-employed which has eased the situation slightly. He told us that he is responsible for the day to day running of the home, with an RMN providing clinical input and a facilities manager responsible for housekeeping, laundry, catering and maintenance. There has been no manager at the home since May 2009 and no registered manager since August 2008. The Operations Manager said he has interviewed someone for the managers role and is very hopeful that she will accept the position. He said they have been making do but the care provision is good. Three staff files were inspected, two were for new care staff and the other was for a nurse. Each contained a job application form, two references, POVA and CRB checks. There was no evidence that one person was supervised between the POVA first check and the full CRB disclosure being obtained. There were no photographs of the two newest employees. Interview records were not seen; we were told that the Operations Manager and the Facilities Manager screen all applications. We were told that they may do preliminary interviews for care staff but a nurse also undertakes an interview. We were told that interviews for the managers role or nursing staff are undertaken by the Operations Manager and the registered manager from another Nursing Home owned by
Care Homes for Older People Page 4 of 11 the Company. Some records of training were seen but no induction records. The nurses file held a job description for a clinical managers post, we were told he provides clinical input but is not a clinical manager. Three care files were inspected and others looked at in less detail. The file of the newest admission did not contain a pre-assessment undertaken by staff at the home but there were assessments from other agencies in the file. There were no care plans for two people and the third had no evidence of a review since December 2008. The files were disorganised and there were care documents for one person, who we were told receives respite care, in another persons file. Some risk assessments including dietary assessments were seen but were not referred to in a care plan. Many forms were incomplete or blank and several were not dated or signed. Daily records were seen and there was also a daily input file which seemed to duplicate the information. The records were not very informative. The Facilities Manager told us there was a lack of synchronisation between the daily notes and the care plans. Staff told us there is an activities coordinator and we looked at the records she maintains. It appears that activities take place three times a week. They are recorded for all residents on one sheet which does not comply with data protection legislation. There are also other tick sheets for individuals. The records were not informative as to what people gained from the activities and whether they demonstrated any emotional response and so on. Comments written on the sheets included Benefited from the attention and Coped fairly well. The date was only partially written on the forms, it did not indicate the year. The inspectors toured the building and found the rooms quite bare and lacking in personalisation. There were not many bedrooms that were unlocked. The home was painted in very pale colours throughout, some bedroom doors had been painted in different darker colours but the paint was scuffed and scratched. Much of the bedroom furniture was dated and in need of replacement. Some unoccupied rooms that had been refurbished were shown to us and were much better although the colour scheme was still extremely pale and not ideal for people with dementia. One room was used for storage and was not locked, one shared room had bedding and bed rail bumpers piled on one bed and some rooms had the bed rail bumpers on the floor which is a cross infection risk. Packs of incontinence pads were seen piled up in rooms on full view. One room had a very strong smell of urine and was depleted of furniture and belongings; this was discussed with the management. On the whole odours were minimal and the home was clean. One person was in her bed but the door to the corridor was wide open, when we questioned this the nurse told us the person was in the lounge. On further examination we found that the list of rooms and occupancy she had been given was not the updated version and some residents had changed rooms. Not providing updated information about the occupancy of rooms is very dangerous practice and could result in serious errors occurring. This was discussed with the management who agreed to address the issue. The wet room shower has not been completed and is used for storage. We were told that another bathroom is going to be converted into the wet room shower. Staff told us they enjoyed working in the home and that the atmosphere was happy and
Care Homes for Older People Page 5 of 11 relaxed. They told us the residents are well cared for and they try to help them be independent and enjoy their days as much as possible. One carer said There is a good atmosphere here now, much better than it was before. Staff interacted well with people using the service during this inspection and appeared to know their individual needs. They were kind and respectful towards them. People using the service were dressed in clean clothes and some that were able were seen moving around the home without restriction. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking
Care Homes for Older People Page 6 of 11 following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 11 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 15 All of the people using the service must have a written care plan that details how their individual care needs are to be met. It must be available to them and must be kept under review. This will ensure that staff are informed and directed on how to meet the changing care needs of people using the service. 19/10/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 3 All prospective people looking to use the service should have a thorough assessment undertaken by an appropriately qualified member of staff to ensure the home can meet their individual needs. The registered provider should ensure that the wet room facility is completed and that other bathing and showering facilities, are reviewed and upgraded where necessary. Thiswill ensure the needs of elderly frail people are met. 2 21 Care Homes for Older People Page 9 of 11 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 3 27 Review the number, skill mix and deployment of nurses to ensure there are sufficient numbers on duty with the appropriate skills and knowledge to care for the people accommodated. A suitable manager should be employed and registered with the Commission to ensure the improvement and continuity of systems and provide leadership for the staff. 4 31 Care Homes for Older People Page 10 of 11 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 11 of 11 - 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!
