Random inspection report
Care homes for older people
Name: Address: Cornwallis Court Residential And Nursing Home Hospital Road Bury St Edmunds Suffolk IP33 3NH one star adequate service 27/05/2009 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: Claire Hutton Date: 2 4 0 5 2 0 1 0 Information about the care home
Name of care home: Address: Cornwallis Court Residential And Nursing Home Hospital Road Bury St Edmunds Suffolk IP33 3NH 01284768028 01284700709 Telephone number: Fax number: Email address: Provider web address: www.rmbi.org.uk Name of registered provider(s): Name of registered manager (if applicable) Miss Elizabeth MacIntyre Hunter Fleming Type of registration: Number of places registered: Conditions of registration: Category(ies) : Royal Masonic Benevolent Institution care home 74 Number of places (if applicable): Under 65 Over 65 10 64 dementia old age, not falling within any other category Conditions of registration: 0 0 1 Maximum of twelve people with nursing needs may be accommodated at Cornwallis Court. 2 Maximum of ten people with dememtia may be accommodated at Geoffrey Dicker House. Date of last inspection Brief description of the care home 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. The
Care Homes for Older People Page 2 of 10 2 7 0 5 2 0 0 9 Brief description of the care home 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. Please contact the home for more details. Care Homes for Older People Page 3 of 10 What we found:
The registered manager of Cornwallis Court had sent us a completed AQQA (Annual Quality Assurance Assessment) on time and giving us some very good information about the service. This is a document that gives us statistical information about the home and its achievements as set out against the national minimum standards and is a selfassessment. We have received regular notification of significant events from the manager of this service. At this inspection we followed themes through from notifications and from the previous requirements we made at the last Key Inspection. We looked at care plans for five people to track how the care was determined and delivered and to see how the level of support required was ascertained. These five people were chosen with the deputy manager to reflect a cross section of the current resident group. We found that in some cases a new format had been introduced that was more person centred. These plans are being introduced in 3 RMBI Homes as a pilot. (Royal Masonic Benevolent Institute) We looked at these formats in detail in Geoffrey Dicker, a small unit for people with dementia. We found care plans in the previous style in Geoffrey Dicker to be very comprehensive and detailed in care given with good monitoring of conditions such as weight linked to nutritional assessments, falls recording and risk assessing placed together to link the two aspects when recording. There was a good example where clear instructions to staff were given for one individual on food they particularly liked (this linked to the needs identified in the nutritional assessment), how the individual may demonstrate they were in pain and how staff could manage this, continence care specific to this individual and advice and suggestions on dealing with behaviour linked to their dementia i.e.giving the individual space at certain times. We saw good evidence of review and staff members knew individuals well and were able to answer any questions posed about care, support and family involvement. We looked at the newer care plan format and these were more person centred and said what care and support was required and whom should provide this. It set out daily routines for morning and evening based around expressed preferences. It set out how someone may like to receive their personal care, medication, skin care and mobility promotion etc. However, there were insufficient daily notes in these new records. We fed back our concerns regarding this. We believe that in order to effectively review the care provided, then how staff delivered care needs be examined and if not recorded then this would be anecdotal. Also following a recent complaint made, the review of care notes made, at the time, was vital in ascertaining the care and support delivered to the individual and could only have been obtained from daily notes made by staff. The manager said she had fed this back to the organisation and they were planning to reconsider this aspect. We also fed back our concern that professional judgements may be lost in the new care planning format with lack of instructions on more complex issues such as management of pressure areas and risk assessments and actions needed in the prevention of such conditions as pressure areas, falls and nutrition. The duty of care needs to be considered with ensuring choice and individuality especially with more medical and complex issues. Care Homes for Older People Page 4 of 10 We found that in all parts of the home staff were not confident about the new model and not clear in how to develop these plans fully. The manager fed back to us after the inspection that training would be given to all staff on the new format in the coming weeks. We looked at a care plan for a new individual in the nursing part of the home. They were admitted on the Friday and we visited on the following Monday and there was not a working care plan sufficiently developed. Discussions were held around developing a basic structure to enable staff to safely care, but also develop a detailed plan once their current needs in this environment had been ascertained. We requested before we left that a plan be developed for staff to follow in respect of diabetes, continence, pressure relief, medication and mobility - all areas that had been identified on the assessment completed before the individual had moved in. This was quickly done using the new format, with supplements from the previous format. The above issues had previously been highlighted by a recent complaint made to the home. The registered persons must demonstrate a more robust approach that is proactive and reviews practice from lessons learnt. We examined the medication systems currently in place and found in Geoffrey Dicker that the storage temperature of some medicines had reached as high as 27 degrees centigrade and no action taken at that point. Guidance tells us that temperatures over 25 degrees centigrade are not adequate. Further that places such as toilets and bathrooms are unsuitable areas for medication storage. Since the inspection the manager has informed us that these cabinets have been moved to a more suitable location in residents accommodation. We also found that one individual was having their medication covertly administered. We requested that the home refer the matter under The Mental Capacity Act 2005 for assessment in order that staff are proceeding in the best interests of the resident. We were told that in the main home they have taken measures to improve the level of errors with medication. They have introduced separate trolleys and plan to move to individual cabinets in peoples bedrooms. We examined current storage and found this was good, with fridge temps regularly monitored and found to be within safe limits. We found audits completed for each of the three areas of home. Each of the three audits we saw found errors and issues that needed better management. Action plans were in place. At time time of our inspection we found that the medication administration record had not been signed for one individual though it was past the time for administration. We asked the deputy manager to look into this matter and resolve the issue. The manager confirmed this had been done and that the resident had received their medication late. However 2 days after inspection we were notified of an error by a staff member that affected 8 residents. We believe that the ongoing errors in medication at this home are putting residents at risk and therefore the systems in place are not sufficiently robust and additional action should be taken. What the care home does well:
The ambiance of this home is very warm, relaxed and welcoming and has a comfortable feel. When we arrived we were made to feel very welcome. A positive lifestyle for people
Care Homes for Older People Page 5 of 10 at this home is promoted and achieved. Feedback from people who use the service is very positive with people saying that the home does very well with activities, trips and entertainment. Residents can be assured that admissions to the home are not agreed until a full needs assessment has been carried out and the home is satisfied that it can meet these needs. We saw good evidence of information gathered before a person moves into the home. The home is well appointed and subject to regular maintenance and so offers a good environment, which means that the residents live in a safe and comfortable home. Staff are appropriately recruited, and we were told by staff that they receive appropriate and sufficient training to meet the needs of the resident group. This includes training on fire and infection control that has been offered since our previous visit. Staff told us that the management is approachable and that they get formal supervision. We were able to see documentary evidence that supported this. The self assessment completed by the manager told us that all 42 care staff have completed their induction training as recommended by Skills for Care and 30 of these have achieved NVQ 2 or above in Care or Health and Social Care. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 10 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 7 of 10 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 Care plans need to be 30/07/2010 written swiftly in order to ensure staff have clear instructions to safely care for residents. This will ensure the ongoing safety and welfare of residents 2 9 13 Residents should receive medicines as prescribed. To ensure their ongoing wellbeing and safety 30/07/2010 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 7 The development of new care plans should ensure that existing good practice is not lost and they should continue to include relevant clinical guidance produced by professional bodies including falls prevention, pressure area care and diabetes. Any medication that is covertly administered should go through the Mental Capacity Act process to ensure staff are
Page 8 of 10 2 9 Care Homes for Older People 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 acting in the best interests of the resident. Care Homes for Older People Page 9 of 10 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 10 of 10 - 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!
