Inspection on 12/05/08 for Cornwallis Court Residential And Nursing Home

This inspection was carried out on 12th May 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cornwallis Court Residential And... 24/05/10

Cornwallis Court Residential And... 27/05/09

Cornwallis Court Residential And... 07/06/07

Cornwallis Court Residential And... 20/12/05

Cornwallis Court Residential And... 29/04/05

Cornwallis Court Residential And... 25/10/04

Cornwallis Court Residential And... 20/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Cornwallis Court Residential And Nursing Home Hospital Road Bury St Edmunds Suffolk IP33 3NH Lead Inspector Claire Hutton Unannounced Inspection 12th May 2008 10:00 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 Court Residential And Nursing Home DS0000024366.V364412.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 Court Residential And Nursing Home DS0000024366.V364412.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cornwallis Court Residential And Nursing Home Address Hospital Road Bury St Edmunds Suffolk IP33 3NH 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) 01284 768028 01284 700709 efleming@rmbi.org.uk www.rmbi.org.uk Royal Masonic Benevolent Institution Care Home 74 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (64) of places Cornwallis Court Residential And Nursing Home DS0000024366.V364412.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 1 Maximum of twelve people with nursing needs may be accommodated at Cornwallis Court. 2 Maximum of ten people with dementia may be accommodated at Geoffrey Dicker House. 7th June 2007 Date of last inspection Brief Description of the Service: Cornwallis Court is situated in very well maintained grounds and gardens. It was originally part of the West Suffolk Hospital. Cornwallis Court opened in June 1981 and has provided care for freemasons since that time. The home can care for up to 74 residents, with up to 12 of those beds used for nursing care and up to 10 for people with dementia. The accommodation offers residents single bed sitting rooms with en-suite facilities. In the main building there were two lounges, one on the ground floor and one on the first floor, and a ground floor dining room. There are also other smaller areas for use by residents who may wish to sit on their own or in a small group. All rooms are comfortably furnished to a good standard, with a continuous program of decoration and upgrading. There is also a well-stocked library. There are bathrooms and WCs, which are well equipped to assist residents and staff. There are a number of kitchenettes for use by residents and their relatives to make hot drinks and snacks. There is also a small shop and hairdressing salon for use by residents. Ramps are provided and pathways maintained to allow residents to access the garden and to enable people wishing to walk around the grounds to do so safely. Geoffrey Dicker House is a self-contained home with lounge, dining room and kitchenette. There is a separate entrance to this part of the home. Fees at the home are dependent on the assessed needs of residents and range from £517.00 - £840.00 per week. Please contact the home for more details. Cornwallis Court Residential And Nursing Home DS0000024366.V364412.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use the service experience adequate quality outcomes. The inspection visit was unannounced and took place on two weekdays. A pharmacy inspector attended on the first day and his findings are in this report. This was a key inspection that focused upon the core standards relating to older people. The report has been written using accumulated evidence gathered before and during the inspection, including an annual quality assurance assessment completed by the home. This is a self-assessment. Surveys were sent to the home and we received 4 completed surveys from relatives, but none completed by residents or staff. Therefore during this inspection 4 residents and 6 staff were spoken with in depth and their comments are included throughout this report. The inspection process included visiting all communal areas of the home, (including the main part of the home, the nursing wing and Geoffrey Dicker House) and several bedrooms, general discussions with staff and residents, observations of staff and resident interaction, and the examination of a number of documents including residents care plans and associated documents, medication records, the staff rota, records and policy relating to health and safety and records relating to staff recruitment. The new manager, and a supporting manager were present throughout the inspection and contributed positively to the process. What the service does well: People who are considering moving into Cornwallis Court will find information is available in the form of a Statement of Purpose and Service Users Guide. They will be able to visit and have their needs assessed by a competent person before they move into the home. Residents can expect to have care plans in place, which reflect their health, personal and social care needs. Medication practices within the home are sufficiently effective to protect people. Residents are consulted about the extensive range of activities and this ensures they are given the opportunity to participate in social, recreational and religious interests of their choice. Cornwallis Court Residential And Nursing Home DS0000024366.V364412.R01.S.doc Version 5.2 Page 6 Cornwallis Court provides sufficient staff that are well recruited, appropriately trained and supervised. Relatives told us ‘In the several years that our relative has been at Cornwallis I find that the staff and carers treat all the residents with great respect and kindness’. A resident told us ‘Cornwallis has good, honest kind staff’. What has improved since the last inspection? What they could do better: Cornwallis Court was overall satisfactorily managed and we believe the service was set to improve, however the current issues around health and safety, complaints and the environment were compromising the quality of service currently on offer. The manager had been in post since December 2007 and needed to apply for registration with the Commission so that we can determine that she is fit to be in charge of this service. There was a lack of clinical supervision available to the nurses within the home as the deputy post that fulfilled this role was vacant. Cornwallis Court Residential And Nursing Home DS0000024366.V364412.R01.S.doc Version 5.2 Page 7 We found that there were 2 complaints outside of the timescales for a response. A resident registered a complaint in October 2007. The service was unable to confirm if the matter had been investigated and had no information to show that the issues had been satisfactorily concluded. In order that people who use this service have confidence in the complaints procedure, complaints must be listened to, promptly investigated and the outcome feedback and concluded in a reasonable timescale. We confirmed that the radiators in the en-suites in Geoffrey Dicker were not working. To ensure the comfort of resident the radiators within the en-suites in Geoffrey Dicker must be fully functioning. In addition the laundry in Geoffrey Dicker must be appropriately processed to ensure the health of residents and staff. We had found evidence that soiled laundry was being inappropriately processed. We also found that residents self-managing their medicines was not regularly assessed to ensure they can properly handle and administer their medicines. These medicines must be secured in resident’s rooms at all times and their security monitored. 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 Court Residential And Nursing Home DS0000024366.V364412.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 Court Residential And Nursing Home DS0000024366.V364412.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): 1, 3, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who are considering moving into Cornwallis Court can expect to have information about the home, be able to visit and have their needs assessed before they move into the home. EVIDENCE: Information about the home, including the Statement of Purpose, Service Users Guide and complaints procedure was issued to each permanent person prior to or on admittance to the home. This information was not routinely given to those people who stayed for respite (2 respite care files examined showed the information have not been given) and the explanation given was that the quantity of information may be overwhelming, but after discussion it was agreed that this would be reviewed. Information about the home was also available as you enter the home attached to the wall. The Service Users Guide and Statement of Purpose were in the process of being updated with some recent changes. Cornwallis Court Residential And Nursing Home DS0000024366.V364412.R01.S.doc Version 5.2 Page 10 Four peoples’ care plans and personal files were tracked. Each person had a pre admission needs assessment completed covering all aspects of their health and personal and social care needs. A registered nurse completed this before they moved into the home and then was used to develop the plan of care. From the relative surveys returned, 100 said they had received enough information about the home. The self-assessment completed by the home told us ‘As far as is possible we visit prospective residents in their own home to talk about what we offer and establish what the individual is looking for. We provide individuals with our Statement of Purpose, which outlines what we offer, what is included in the fee charged and what is not. The document also sets out our aims and objectives and can be issued in large print or any other format that is needed. Anyone wanting to come in to the home has an in depth assessment of needs carried out prior to admission and they are then informed verbally and in writing whether or not we can meet their needs. Prospective residents can visit the home as many times as they wish prior to admission, can join us for part or the whole of a day and join us for a meal of their choice. Once a person is admitted they will chose their bedroom (if more than one room is available) and will be issued with a contract. We try as far as is possible, to buddy new residents up with longer stay residents who can spend time with them, explaining who is who and orientating them to the home’. The Home does not provide intermediate care. Cornwallis Court Residential And Nursing Home DS0000024366.V364412.R01.S.doc Version 5.2 Page 11 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 and 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to have care plans, which reflect their health, personal and social care needs. Medication practices were largely effective to protect people however improvements still need to be made with respect to selfmedication. EVIDENCE: Four care plans were examined from various parts of the home. These were found to be up to date and had evidence of recent review. The four staff spoken with all confirmed that care plans provided enough information for them to provide the correct support and nursing care for individuals. One staff member said ‘new individual plans are being developed’. Another person said ‘currently the care plans are being reformatted and these are better’. One staff member said ‘All care plans are updated monthly and we always get a good handover about current developments’. Cornwallis Court Residential And Nursing Home DS0000024366.V364412.R01.S.doc Version 5.2 Page 12 Care plans were supported by risk assessments completed on nutrition, manual handling, fall prevention and pressure area prevention. Plans did include details of funeral arrangements and a discussion was held with the mangers to encourage further development in this area and to further involve residents in the development and review of their care plans. As two plans examined did not indicate that the resident had been consulted or informed about the plan of care. When speaking to residents they spoke very highly of the care and support they received. One resident said ‘Yes I like the care staff, they help me’. Another resident said ‘They are good honest, kind staff’. All residents spoken with confirmed that their privacy and dignity was ensured. Staff were asked about how they ensured privacy and dignity and one staff member said ‘If I’m supporting someone with personal care I always make sure doors are closed, curtains drawn and towels or sheets are draped in a way to preserve modesty. If I’m hoisting someone in a communal area I would go and get a mobile screen and place this around us, so no one else can see’. Staff were observed to follow good practices when offering and completing personal care tasks. Relatives told us ‘In the several years that our relative has been at Cornwallis I find that the staff and carers treat all the residents with great respect and kindness’. Another relative told us ‘our relative has had a number of small strokes, their mental state is very poor. The care they receive is first class and the family are very satisfied with it’. The inspection of the medication standard was conducted by the Commission’s pharmacist inspector on 12/05/08. He found that overall the home has good systems in place to ensure that medicines are managed and given safely to residents. He also found that where needed, matters relating to resident’s medication are promptly referred to prescribers who attend the home regularly. When conducting sample audits of medicines the inspector found no discrepancies. Therefore, records indicate that medicines can be accounted for and are being given to residents in line with prescribed instructions. Controlled drug records also accurately reflect their administration to residents. When asked, the manager confirmed that there have been no recent incidents relating to errors in medication since when last reported to the Commission in February 2008. Medicines are handled and administered by staff who have received training, have recently attended a staff meeting relating to medication and who are due to attend further training. However, the home so far has not put in place measures to regularly assess the competence of staff. It was found that sometimes medicines rounds scheduled for evening are not given until as late as 11.30pm. Cornwallis Court Residential And Nursing Home DS0000024366.V364412.R01.S.doc Version 5.2 Page 13 As this is too late for some residents, the manager said that she plans to ensure a further senior member of care staff is on duty to enable these medicines to be administered more promptly and as scheduled. The home makes provision to enable residents to retain independence and manage their own medicines where appropriate. Some residents handle only some of their medicines such as eye drops and some of their oral medicines. Whilst there were records of risk assessments in place, some were not reviewed frequently and some did not record that residents were able to safely handle medicines such as eye drops to ensure they are properly selfadministered. It was also found that one resident had medicines in his room that were not secure. The security of medicines in such resident’s rooms was also not being monitored by staff. There are residents prescribed medicines of a psychoactive nature. Some are prescribed for administration at the discretion of staff when they are needed. Whilst there was found to be written guidance available for staff when managing resident’s behavioural disturbance, it was found that this does not provide sufficient detail to inform staff specifically when doses of the medicines should be considered for administration. It has previously been raised as a concern that the home has used unsafe techniques for administering medicines by decanting them into secondary containers prior to use. This was discussed at the recent medication meeting held at the home on 06/05/08. Staff said this practice was no longer adhered to at the home but it was noted that equipment to enable this was still available in medicine storage areas. Cornwallis Court Residential And Nursing Home DS0000024366.V364412.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including a visit to this service. Residents can expect to be consulted about a range of excellent activities. People can expect to have a good range of food as part of a balanced and varied diet. However not everyone may find it appealing or feel that their wishes regarding meals have been listened or responded to. EVIDENCE: This home provides a full range of activities for residents. The variety is endless and most are organised through a resident group. One resident spoken with confirmed they were on the committee that arranged activities on a quarterly basis and had produced the recent review/report on those activities. The report was available on the wall in the entrance area. There was an activities schedule for all to see. There were 3 or 4 activities each day. These ranged from in-house arrangements such as hair and beauty, manicures and hand massages, scrabble, bingo and for the more energetic carpet bowls. There were flower arranging workshops, guitar playing and music appreciation. For those who wished to be more social there were afternoon speakers and trips out for a social and lunch at a local pub. Cornwallis Court Residential And Nursing Home DS0000024366.V364412.R01.S.doc Version 5.2 Page 15 Services of worship were held within the home and residents could also attend worship outside the home. The home has a minibus and there were regular trips into Bury St Edmunds town centre and residents had recently gone to Haughley Park to see the blue bells in flower. One resident spoken with said ‘I like the fact I can go to church. I do not like the other activities on offer’. Two other residents spoken with said they did like the variety of activities on offer. In terms of socialising the home was not segregated in any way. Residents from the nursing wing use the main lounge and dining room as they preferred. Some residents from the nursing wing also regularly went over to Geoffrey Dicker. On the first day of our visit to the home we saw 3 residents from the nursing wing attending a craft session that was running in Geoffrey Dicker. The newly appointed activities person was running this. This person now works 5 days a week and was still in the process of developing activities for people who require additional social support. Through individuals records we were able to see that time had been spent with people on a one to one basis as well as in small groups. The program of activities was developing and was based around arts, crafts and creating games. There were also plans to develop the use of the garden at Geoffrey Dicker. One relative had told us that they wanted to see more ‘fun therapy’ within Geoffrey Dicker house and this new appointment addresses this matter. The self-assessment completed by the home told us ‘everyone is encouraged to maintain contact with family, friends and the local community and visitors are welcome at anytime. Family can stay for a meal with the resident if they wish. We also have a guest room which enables relatives/friends to stay overnight’. A relative told us ‘we are kept in constant contact regarding our relatives dayto-day concerns. The staff do their best to make all residents comfortable and relaxed’. Another relative told us ‘on two occasions when our relative has been admitted to hospital we have been informed very quickly. When staff have called in a doctor we have been told immediately’. One resident said they could receive visitors whenever they wanted them but that they usually kept in contact by telephone. This particular resident chose to have 2 telephones. Residents spoken with said they could determine how they spend their day. One resident said they choose when to go to bed, but some people start to go to bed as early as 7pm. In relation to catering within the home, there has been a prolonged discontent with the catering that we have reported on in previous published reports. Therefore this was assessed on this occasion. The main dining room was very spacious. The tables were nicely laid out with condiments, tablecloths and napkins. There were also 2 smaller dining rooms in the nursing wing and Geoffrey Dicker. Food was transported in a hot trolley to these smaller dining rooms. Cornwallis Court Residential And Nursing Home DS0000024366.V364412.R01.S.doc Version 5.2 Page 16 Menus were displayed for residents to see and choose from. There was a main choice, an alternative and a salad on offer for the main meal of the day. The head chef explained that if this were not suitable then they would make an omelette of something else of the residents choosing. They went on to explain that in order to listen to the views of the residents about catering matters there was a monthly forum where issues could be raised and resolved. In addition to this each day feedback on the meal eaten was sought from each area of the home (main dining room, the nursing wing and Geoffrey Dicker). On the second day of our visit we saw that staff in the nursing wing had to raise a concern that the vegetables were inadequately prepared as they had requested these to be prepared for people who required a ‘soft’ diet. There was also a formal catering questionnaire that had been commissioned and the results were to be published on a graph with an external catering manager to review them. In March 2008 the local environmental health department had visited. The report had contained 1 recommendation about locking food waste. This was said to have been actioned. The home had been awarded a Food Hygiene Award for 2008 and this was displayed within the main dining room. Three residents had requested to meet the Inspectors and wanted to discuss their dissatisfaction over the catering arrangements within the home. One resident said that ‘the food is deplorable. The menu is ever repeating and does not change’. Another resident said ‘the mid day meal is terrible. It tastes like prison food and is not tasty. There are always carrots in the winter. It is seen as a crime not to eat what is put in front of you’. Another resident said ‘the food is dreadful the only answer is to get control again’. When asked if they used the processes set up by the home to respond to catering matters this small group of residents believed the processes were ineffectual and they had tried but nothing changed. These residents were not willing to make a formal complaint as they believed this would not change matters and the only solution would be to change the catering company currently at the home. Cornwallis Court Residential And Nursing Home DS0000024366.V364412.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is adequate. 16 and 18. This judgement has been made using available evidence including a visit to this service. Residents at Cornwallis Court are protected. Residents may be listened to, but their concerns may not be taken seriously or actioned promptly. Residents are unable to influence change with their home. EVIDENCE: In relation to dealing with complaints the self-assessment told us ‘We have a clear complaints policy/procedure and copy is given to new resident upon admission. Complaints are dealt with quickly and efficiently’. However we found that people who move into the home for a short period of time were not routinely given the complaints procedure. Two files examined showed that this matter had not been covered by staff when inducting those residents to the home. The self assessment also told us that the service had received 5 complaints in last 12 months. 80 had been addressed in 28 days. (The standard is that complaints are to be responded to within 28 days) 2 had been upheld and 1 was awaiting an outcome. One of these complaints was a matter that we the Commission had referred to home. We examined the complaints log and found that a resident had complained in October 2007 about the conduct of a staff member. This matter was discussed with the manager and they were unable to confirm if the matter had been Cornwallis Court Residential And Nursing Home DS0000024366.V364412.R01.S.doc Version 5.2 Page 18 investigated and had no information to show that the issues had been satisfactorily concluded. As part of this inspection we completed a thematic probe around the area of safeguarding adults from potential abuse. As part of this we asked 4 staff, 3 residents and the manager specific questions about safeguarding within the home. The self-assessment told us ‘We have a Safeguarding Vulnerable Adults policy/procedure and staff undergo yearly mandatory training to cover Abuse and POVA, Disclosure and Whistle blowing and to make sure they are aware of how to prevent abuse from happening. The training also outlines clients rights and how staff can respect these rights.’ The manager since starting in December 2007 had completed a training audit and found that 45 staff in the last year had not received this training and therefore set about updating and training all staff. So far 23 of those staff identified have been trained with more dates planned. All but 1 staff spoken with confirmed they had received safeguarding training and the whistle blowing procedure was part of this. One staff member said ‘I think the term safeguarding means protection from themselves, staff, objects and equipment. They have to have the right food and ensure their skin is of good integrity’. Another staff member said about safeguarding ’It means to keep people safe from abuse. Give them the best care’. Another staff member said ‘Safeguard them from abuse and neglect’. This shows there is some good understanding of some of the staff. We asked residents if they felt safe at the home and whom would they speak to if they didn’t. One resident said ‘I do not wish to discuss with you about my safety’. Another resident said ‘I know who to speak to’. Another resident said ‘I would have a word with the manager’. The manager told us ‘any issues that arise will get referred to the local authority and police if necessary. Only if we get the OK from them would we do an investigation. I’m confident my staff do know what to do. Residents do know their rights. We have service user meetings – they do speak up. They can always see me – I have an open door policy and up until recently I have been doing very regular corridor visits – going out and seeing the residents. I feel they trust me as a manager. We also have our quality assurance processes. I feel you could always know more about safeguarding, but I’m aware of the local website and I have used this to access information’. The self-assessment, talking to staff and looking at records all confirmed that staff were robustly recruited and this included a CRB (criminal records bureau) check and a POVA (protection of vulnerable adults) 1st check. Cornwallis Court Residential And Nursing Home DS0000024366.V364412.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is adequate. 19, 20, 21, 22, 24, 25 and 26. This judgement has been made using available evidence including a visit to this service. Residents can expect to live in a home that is clean, well maintained and have access to specialist equipment they require to help maximise their independence. However safety and comfort in all areas of the home cannot be assured. EVIDENCE: Time was spent touring the whole home. The home was very clean. All rooms were on a regular redecorating plan. Bedrooms were decorated as they became vacant. The new en-suites in the main part of the home were very modern and light and gave a good quality provision to those residents. In a survey completed by a relative they told us that the radiators in the ensuites in Geoffrey Dicker did not work. These were examined and it was explained that they never did work since installation. Cornwallis Court Residential And Nursing Home DS0000024366.V364412.R01.S.doc Version 5.2 Page 20 This situation would not only cause physical discomfort when it was cold weather, but for someone with dementia trying to adjust a radiator to no effect could cause confusion. This situation was discussed with the manager who gave an assurance that this matter of functioning radiators in the en-suites would be resolved before the weather turned colder later in the year. The self-assessment told us: ‘Residents are encouraged to treat the Home as their home and to enjoy their life. The Home is clean, well maintained and odour free. We have adapted baths (assisted) and a selection of adapted wheelchairs which have been allocated to residents following assessment by wheelchair services. We have hoists and various slings for transferring residents. Staff keep a cleaning rota to ensure equipment is cleaned. There is a call system in each bedroom, bathroom and toilet. The Home is maintained to a very high standard and the grounds are kept tidy’. This information was confirmed during a tour of the home. The self-assessment also told us: ‘The lounges and corridors are spacious with a large dining area. The toilets have high or low seats with grab rails to enable clients to use them independently. We have emergency lighting. The laundry has a separate clean, soiled and infected area and we use dissolvo sacks for infected linen. Staff are trained to dispose of laundry following a policy and procedure. We have clear guidelines and procedures to dispose of clinical waste, we have sluice cleansers at various points throughout the home’. We looked at the laundry situation in Geoffrey Dicker House and found that staff were not adequately laundering soiled clothing. We found that underwear specifically to manage continence was being laundered in a domestic machine along with other items. This current situation compromises the health of both residents and staff. Records showed that hot water temperatures were regularly taken to ensure safety from scalding. A shower was noted as not being on the records but used by residents. A temperature of 46°c was recorded on day one of our visit. This is sufficiently high to cause harm. This was immediately addressed before the end of our visit and was brought down within safer limits. It was explained that the current restrictors on the water supply would be replaced as they were coming to the end of their functioning life. On the first floor of the main building there was a veranda area. The day was warm and residents freely accessed this area. Discussions were held around the current situation and if a risk assessment had been completed. The manager agreed to assess the risk presented to those who had access to this area to ensure the facility on offer was as safe as it could be. Cornwallis Court Residential And Nursing Home DS0000024366.V364412.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is good. 27, 28, 29 and 30. This judgement has been made using available evidence including a visit to this service. Cornwallis Court provides sufficient staff that were well recruited, appropriately trained and supervised. EVIDENCE: The staff roster for the current week was seen. Staffing levels in the main house usually consisted of nine care staff in a morning and 6/7 in an afternoon. This was currently for 48 residents. In the nursing wing there were 3 carers and a nurse in a morning and 2 carers and a nurse in the afternoon. This was to support 10 residents. In Geoffrey Dicker there were 3 staff on duty at all times during the day and at night in Geoffrey Dicker there were 2 care staff. At night in the main building there were 3 care staff and a nurse on duty for both the residential wing and nursing wing. As stated in a previous section the medicine round at night can take too long for some residents, therefore an additional staff member is planned on nights for the main house. A resident told us that staff generally do respond promptly to the call bell. The resident could only recall one occasion when they had to wait. In addition to the care staff the home employ 2 maintenance people, separate cleaning, laundry and catering staff. As well as chefs the home employ dining room staff and this was usually 4 staff in attendance for the main meal of the day. The was also 2 administration people employed. With the new Cornwallis Court Residential And Nursing Home DS0000024366.V364412.R01.S.doc Version 5.2 Page 22 developments of the activities person, the increase of cleaning staff at a weekend and the additional planned person on nights we believe the home to be adequately staffed. Relatives comments about staff included; ‘I have no negative comments - the care staff I am in contact with during my visits do their utmost to look after their charges. More staff should however be available. The job is very demanding - patience, stamina and a happy disposition are vital’. Another relative said; ‘My relative has recently been moved within Cornwallis. All the staff have shown my relative wonderful care and patience. They are very happy to discuss any problems regarding their care with me’. Three staff files seen confirmed the home operates a thorough recruitment process, which includes obtaining all the appropriate paper work including Criminal Bureau Records (CRB) check and Protection of Vulnerable Adults (POVA) checks. All staff files seen had a statement of terms and conditions of employment signed and dated. Newly recruited staff had completed a formalised induction programme. This training introduced the employee to the principles of care, safe working practices, the organisation and role of the worker and the experiences and particular needs of the resident group. Records confirmed that existing employees have completed training using local resources. Recent training consists of fire safety, moving and handling, food hygiene, safeguarding, medication administration and care planning. Four staff spoken with confirmed they had received this training as did sampling training records. The self-assessment told us; ‘Skills for care foundation training for staff and all staff have induction training. Staff undergo NVQ 2 and 3 training. Mandatory training for all levels of staff from in house trainers trained for the role and from outside training providers. Staffing levels as required to meet the needs of the residents. A skill mix of various grades of staff to provide 24 hour care. Additional domestic staff to ensure cleanliness and standards are maintained. Additional staff to man the laundry throughout the day. Rotas are compiled to utilise the skill mix on each shift and adapted to meet the needs of the residents. All staff employed go through a rigorous selection procedure of interview, 2 references CRB, POVA check and health referral before recruitment. We select the right person for the job making sure we can build a team of good quality care staff. We recruit for attitude, not just experience’. Cornwallis Court Residential And Nursing Home DS0000024366.V364412.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is adequate. 31, 32, 33, 35, 36, 37 and 38. This judgement has been made using available evidence including a visit to this service. Cornwallis Court was adequately managed and is set to improve, however the current issues around health and safety, complaints and the environment are compromising the quality of service currently on offer. EVIDENCE: There had been a change in manager since last inspection of this service. The new manager had been in post since December 2007 and we have yet to receive an application to register them. The new manager had NVQ 4 and the registered managers award and has had pervious experience for this role. The manager did have a deputy and an assistant, but they had chosen to resign. These posts were currently being advertised and the home needs to recruit a level 1 nurse to ensure that nursing staff have appropriate clinical supervision available to them. Cornwallis Court Residential And Nursing Home DS0000024366.V364412.R01.S.doc Version 5.2 Page 24 The organisation had put in an additional temporary manager to offer support. In speaking to the 4 staff all spoke very highly of the new manager. One staff member said ‘She is excellent, kind, caring and understands what is best for the home’. Another staff member said ‘the changes she has made are for the better. She is fair and has brought structure to the home’. We enquired about how the home seeks the views of residents and how they assure quality. We have commented upon the regular meetings to discuss catering, there are also regular residents meetings. The home had commissioned an outside agency to audit their quality of service. They had chosen a well-respected well-known firm in the area of care services. It included seeking the views of residents and relatives and they had developed an action plan that was available for us to examine. This covered all aspects of the home such as management, care, catering and the environment. The self-assessment told us; ‘The Management and administration team work effectively to run the Home and are committed to ensuring the health, welfare and safety of residents and staff. The Manager maintains high standards and keeps clear records. She communicates policies/procedures to staff and ensures these are followed.She ensures staff have appropriate training and monitors training records. Staff have regular meetings and feedback. The management style at the home is firm but fair. We ensure the health, safety of residents, staff and visitors is promoted at all times. We maintain good records to follow health and safety requirements’. We have reported on some health and safety matters in the environmental section of this report and have made a requirement and recommendations to further develop the safety of residents and staff. The self-assessment confirmed that maintenance and servicing of equipment was up to date. During our visit we sampled some records. The home had commissioned an outside company to develop a fire risk assessment. We saw servicing records for hoists and that the recommendations had been actioned. We saw that water was tested to prevent Legionella and that windows on the first floor were restricted. All of these actions go towards maintaining the safety of the residents and staff within the home. In respect of residents finances the home does not act as appointee or signatory in any financial transactions. They do however manage small amounts of money on behalf of a small portion of residents. In these cases we saw that appropriate records were kept with receipts and there was an audit trail that would protect the residents and staff. Four staff spoken with during the inspection confirmed they felt supported in their work and were clear about their roles and responsibilities. Two staff confirmed that they received formal supervision. From the 4 staff files examined 2 contained evidence of recent supervision, but previous long gaps. Two other staff files did not show regular or recent supervision. Cornwallis Court Residential And Nursing Home DS0000024366.V364412.R01.S.doc Version 5.2 Page 25 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 3 X 3 3 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 3 2 X 2 3 X 3 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 2 3 2 Cornwallis Court Residential And Nursing Home DS0000024366.V364412.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement Action must be taken to ensure the safety of residents selfmanaging their medicines is regularly assessed to ensure they can properly handle and administer their medicines. These medicines must be secured in resident’s rooms at all times and their security monitored. Timescale for action 08/08/08 2. OP16 22 In order that people who use this 08/08/08 service have confidence in the complaints procedure, complaints must be listened to, promptly investigated and the outcome feedback and concluded in a reasonable timescale. To ensure the comfort of resident the radiators within the en-suites in Geoffrey Dicker must be fully functioning. The laundry in Geoffrey Dicker must be appropriately processed to ensure the health of residents and staff. 08/09/08 3. OP21 23 (2) 4 OP26 13 (3 ) (4) (c) 08/08/08 Cornwallis Court Residential And Nursing Home DS0000024366.V364412.R01.S.doc Version 5.2 Page 27 5. OP31 7(1) The manager must apply for registration with the Commission so that we can determine that she is fit to be in charge of this service. 08/08/08 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. Refer to Standard OP9 Good Practice Recommendations It is recommended that the competence of staff handling and administering medicines be monitored on a regular basis. It is recommended that detailed information is included in written guidance in relation to the use of medicines prescribed for administration at the discretion of staff to manage resident’s behavioural disturbance. It is recommended that equipment that could be used to follow unsafe medicine administration procedures be removed from the home. Thermostatic valves on hot water should be replaced to ensure the ongoing safety of residents. An assessment of the risk to those who have access to the veranda should be made to ensure the facility on offer is as safe as it can be. Staff must receive regular supervision to ensure they adopt the policies, procedures and training given by the home. 2. OP9 3. OP9 4. 5. OP19 OP19 6. OP36 Cornwallis Court Residential And Nursing Home DS0000024366.V364412.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Court Residential And Nursing Home DS0000024366.V364412.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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