Inspection on 07/06/07 for Cornwallis Court Residential And Nursing Home

This inspection was carried out on 7th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 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... 12/05/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Cornwallis Court Residential And Nursing Home Hospital Road Bury St Edmunds Suffolk IP33 3NH Lead Inspector Jo Govett Unannounced Inspection 09:30 7 & 8th June 2007 th 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.V335284.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.V335284.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 www.rmbi.org.uk Royal Masonic Benevolent Institution Mr Alan James McMahon 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.V335284.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. 20th December 2005 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 £474.00 - £750.00 per week Cornwallis Court Residential And Nursing Home DS0000024366.V335284.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Unannounced Inspection of Cornwallis Court and took place over a day and a half on 7th and 8th June 2007. It was a “Key” inspection, which focused on the core standards relating to Care Homes for Older People. Standards not inspected have been met at the previous inspections and there was no information to suggest this situation had changed. The report has been written using accumulated evidence gathered prior to and during the inspection. The Registered Manager, Mr Alan McMahon and the Deputy Manager were both given an overview of the CSCI’s developing role in regulating social care services (Inspection for Better Lives). They were both positive about the inspection, and were happy to discuss all aspects of the service provided. The inspector spent time in each part of the home – Geoffrey Dicker House which provides care for ten people with dementia, the nursing wing which provides nursing care for up to twelve people and the residential area which accommodates fifty-two people. CSCI surveys were sent to a sample of people living/working at the home to complete if they wished. Surveys from forty-three residents, eleven relative/visitors, nineteen staff and three health care professionals were returned directly to the CSCI. We were able to speak with residents freely about their experience of living at the home. Comments from completed surveys and discussion with residents, staff and other interested parties, have been incorporated into this report. In addition the Registered Manager completed a Pre Inspection Questionnaire and provided further information at the request of the inspector. What the service does well: • The home is generally well maintained and has a welcoming and homely atmosphere. There are large communal areas in the main residential wing and enough space with relatively private areas (aside from residents bedrooms) to sit, read or chat with other people. Comments made about the home include: “Nothing is too much trouble for staff!” “Staff at all levels are excellent…” “(resident)….is happy and contented in the home…it has given (them) a new lease of life…” “They know that this is a home first, so there is a sense of calm and comfort.” Cornwallis Court Residential And Nursing Home DS0000024366.V335284.R01.S.doc Version 5.2 Page 6 • • The home is proactive in providing a variety of activities and events for people living at the home. The planned appointment of another activities coordinator, specifically for Geoffrey Dicker House will go further to improve and enhance the daily life and social activities within the home for all. What has improved since the last inspection? • The home has introduced consultation about meals and established a catering committee that includes both people living at the home and the catering company. Results from surveys regarding meals were varied. Those spoken with during the inspection felt that some improvements had been made. Medication Administration Records clearly showed the level of dosage required and could provide an audit trail to explain if and why it needed to be altered. Weekly medication audits have also been introduced where mistakes are highlighted and investigated. The home has also considered and implemented some changes from the recommendations made by a pharmacy inspector at the last inspection. • What they could do better: • Whilst many aspects of the home are positive, shortfalls in key sections of this report (Staffing and Complaints and Protection) have effected quality outcomes. Management are aware that the current staff morale at the home is low, with staff surveys showing that there is a significant level of dissatisfaction with management. Whilst the Registered Manager and Deputy expressed a clear desire to “move on” the home needs to ensure that people working at the home feel their opinions are listened to. Recruitment records must include all the information required to fully ensure that residents are safeguarded from the risk of unsuitable staff. The home needs to continue to work with residents and the catering company to monitor the quality and experience people have of meals provided. In addition the home needs to evidence that those people living at the home who are less independent or able, are given the same choices and opportunities regarding daily living and activities. The home needs to review the duties staff undertake to ensure that resident’s needs can be met appropriately and their health and welfare protected as far as possible. • • . • Please contact the provider for advice of actions taken in response to this inspection. Cornwallis Court Residential And Nursing Home DS0000024366.V335284.R01.S.doc Version 5.2 Page 7 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.V335284.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.V335284.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 5 (Standard 6 is not applicable). Quality in this outcome area is good. Residents can expect the home to appropriately assess their needs prior to moving in. They should be confident that if offered care and accommodation their needs can be met by the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The assessments of two new residents were seen. They included all the elements required by National Minimum Standard 3. Where nursing was required information had been included about the person’s condition and requirements for ongoing treatment. Residents spoken with during the inspection all said they or their relatives had visited Cornwallis Court before moving to the home. Of those residents who returned a survey, thirty-five out of forty-one residents who answered, felt that they had enough information about the home before they moved in. Cornwallis Court Residential And Nursing Home DS0000024366.V335284.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11. Quality in this outcome area is good. People living at the home can expect that they will have a plan of care, which aims to meet their needs and reflect their choices. This should ensure that their care needs are met, risks identified, and they remain safe as fare as possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Five care plans were examined from each area of the home. They reflected residents with differing needs such as nursing, dementia and frailty. The home is introducing a new care plan system and each area of the home was at different stages of the transfer. Overall they included good information about the resident’s needs and how they should be met. A resident with dementia, living at Geoffrey Dicker House) had a detailed life history and information on how their behaviour (due to stress) could be approached by staff. In addition risks were identified such as “social isolation” and there were instructions for staff on how to encourage the resident to partake in activities and discussions. A care plan for a more independent person living in the main residential building included a “summary of past life”, significant medical history and Cornwallis Court Residential And Nursing Home DS0000024366.V335284.R01.S.doc Version 5.2 Page 11 health and social care assessment. All care plans included relevant risk assessments such as moving and handling and skin viability. Each area of need had its own plan of care identifying the need, overall goal and aim, action to be taken and an evaluation that showed the plan had been reviewed in line with risk assessments (usually once a month but more frequent if necessary). Staff generally welcomed the new care plans. It was noted that some of the pre-populated “actions” lacked detail where people’s care is more specialised. The practice of keeping a bath list, observed on the notice board of the nursing area and a clip board in Geoffrey Dicker House) is considered institutional and it was fedback to staff that this practice should stop. Care plans included records of referrals and appointments with other health care professionals such as physiotherapists, chiropodists etc. During the inspection two residents said that the home helped organise travel to and from hospital appointments. One visiting health care professional commented that staff ask their advice, read their care plan entries and follow the guidance and recommendations. Care plans seen evidenced that residents and/or relatives had given instructions about what to do in event of their death. Surveys returned from residents included the following results: Always 28 Usually 13 Sometimes 1 Never 0 No Answer 1 Do you receive the care and support you need Do the staff listen and act on what you say? Yes 36 No 1 No Answer 6 Medication practice and procedures were observed in each area of the home. It was noted that where needed, the dosage of medication had been recorded on Medication Administration Records (MAR). In the case of a resident taking Warfrin records showed where a change in dosage had been required and this tallied with requests from health professionals. The Controlled Drug Register was found to be complete and accurate. Where medicated cream had been prescribed, it had not always been recorded as administered on the MAR sheet. Weekly drug audits are being undertaken with checks against a comprehensive list of checks. Staff confirmed that when a mistake is highlighted it is discussed with the person responsible, and any further action needed is recorded. Cornwallis Court Residential And Nursing Home DS0000024366.V335284.R01.S.doc Version 5.2 Page 12 Geoffrey Dicker House, the nursing wing and the residential areas of the home each have a small office area where medication is kept. Senior staff on each wing are trained to administer medication. However, controlled drugs are all kept on the nursing wing. Staff and management confirmed that a nurse administers all controlled drugs at the home. We discussed the implications of the nurse leaving the nursing wing, and the experiences of this system in both the residential area and Geoffrey Dicker House. It was noted that controlled medication was being transported to other parts of the home in a pot with no lid. Managers agreed that there was potential to improve this system and ensure that nursing staff were not taken away from the nursing wing for more time than necessary. CSCI had also been made aware of a situation where a nurse had not been present at the home during a night shift. Cornwallis Court Residential And Nursing Home DS0000024366.V335284.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. Overall residents can expect the home to address their social and recreational needs and provide a varied diet. Continued monitoring and improvement should go further to ensure that individual’s choices are safeguarded and respected, especially where residents are less independent. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a full time activities coordinator who the inspector was able to meet with during the inspection. They stated that organising activities for 74 people was quite difficult, because of the large range of needs the home provides care for. However they were very positive about their role and its importance in the daily lives of residents. They were pleased that the home was about to recruit another activities co-coordinator for 20hrs a week, specifically for people living at Geoffrey Dicker House. Information about events and activities were posted on notice boards throughout the home. On the day of inspection residents from each area got involved with flower arranging. Other recent activities included craft classes, film afternoons, music and concerts. The home has a mini bus, which they can Cornwallis Court Residential And Nursing Home DS0000024366.V335284.R01.S.doc Version 5.2 Page 14 use to take people on outings, go shopping or take residents to church. Some residents are part of the activities committee, which comes up with ideas and organises and prepares for events. Surveys showed that thirty-one out of forty-two people who answered said they “usually” or “always” found there were activities arranged that they could take part in. Some staff commented that less able residents found it difficult to join in. The activities coordinator said that more staff were getting involved with the activities which was helping. One resident commented; “I don’t attend activities as I am hard of hearing and am unable to communicate well”. One relative commented “ “…we would welcome more effort to involve/provide activities suitable for (resident) taking into account (their) severe lack of memory”. Residents spoken with during the inspection said that they were able to receive visitors at any time either in private or in one of the large communal areas of the home. All relatives/visitors who returned a survey said that they can visit people in private. The home contracted out catering to an outside company around two years ago. The CSCI has been aware of residents concerns regarding their opinion that this change has led to a drop in the quality of meals. The home had introduced more consultation with residents to try and resolve issues. There is now a catering committee (which includes four residents), comments cards are left in the dining room for residents to complete if they wish, and the cook asks residents for feedback after the main meal. Whilst this was observed in the main dining room for the home it was not clear how residents eating meals in the nursing wing and Geoffrey Dicker House gave feedback. The current budget for meals was £3.34 per person per day. Menus reflected a wide variety of choices although some residents were concerned about the quality of food, mainly the age of fresh vegetables. Previous concerns about individual/specialised diets had been addressed. Each resident has an “order sheet”. Examples were seen of a resident who required a gluton free diet and others who required a soft diet. Additionally the kitchen was seen to respond to a resident’s request on their form for different vegetables. It was discussed that when a new resident moves into the home an information sheet about their likes/dislikes and dietary requirements would be helpful and allow the kitchen time to buy in or make alternative meals. The home had tried a “buffet” style meal with a variety of food for residents to choose from in the main dining room. This had been an idea put forward by the committee. Whilst many residents enjoyed this event, some concern was raised from staff regarding less able residents, although they said they had been provided with an alternative hot meal. Residents from Geoffrey Dicker House and the nursing wing were offered the buffet meal but there was only a small take up. The management team were shown records of food choice from Cornwallis Court Residential And Nursing Home DS0000024366.V335284.R01.S.doc Version 5.2 Page 15 Geoffrey Dicker House where all the residents were recorded as wanting the same meal choices. For example on the 5th and 6th of June 2007 all ten residents chose the same main lunchtime meal and pudding despite there being several other choices on the menu. Surveys from residents showed the following: Always 7 Usually 23 Sometimes 11 Never 0 No Answer 2 Do you like the meals at the home During the inspection the majority of residents spoken with felt that the food was improving, comments were varied but included: “Yes I do enjoy them most days as we do have a choice.” “(they)…accommodate willingly with my taste.” “Meals are getting better.” “I find dinners uninteresting.” “The meals are not always hot, this does need to be improved.” Cornwallis Court Residential And Nursing Home DS0000024366.V335284.R01.S.doc Version 5.2 Page 16 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 & 17. Quality in this outcome area is adequate. Residents and their representatives know how to complain although not all are confident about the homes approach to addressing them. Shortfalls in recruitment practice do not ensure that residents are protected as far as possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Ten of the eleven Relatives/visitors surveys returned stated they were aware of the homes complaints procedure. Discussion with residents and results from surveys show that the majority of residents know who to speak with if they are not happy and know how to make a complaint. All nineteen staff who returned a questionnaire said they knew what to do if a resident/relative or friend has concerns about the service, although one commented “…but often procedure within the home falls below standard and issues are glossed over.” During the inspection two residents said they had raised concerns with the managers but felt they had not been resolved satisfactorily. Another resident commented that they “….would worry about making a complaint as I would feel it would go against me”. The CSCI asked the Registered Provider (18th April 2007) to investigate an anonymous complaint under its own complaints procedure and report its findings. The Registered Manager said that representatives from the RMBI investigated issues during an unannounced visit to the home on the 23rd April Cornwallis Court Residential And Nursing Home DS0000024366.V335284.R01.S.doc Version 5.2 Page 17 2007. Although some actions had been taken as a result, at the time of this inspection the report and full outcome was not available at the home. The homes training programme includes issues around abuse and further training has been undertaken on Protection of Vulnerable Adults (POVA). The home has an appropriate policy and procedures in place for protection. In addition the policies and procedures for recruitment reflect actions needed for the safeguarding of residents. Despite this three staff files did not include all the information required by regulation (see section staffing) although all three did have the appropriate Criminal Records Bureau (CRB) Disclosures. Managers confirmed that no staff work prior to receiving the Enhanced CRB. Dates of recruitment and first shifts worked confirmed this. Cornwallis Court Residential And Nursing Home DS0000024366.V335284.R01.S.doc Version 5.2 Page 18 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 good. Overall residents usually benefit from a well-presented and homely environment, however the lack of domestic staff at weekends does not ensure that this will be maintained consistently and could potentially place residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The main communal areas in Cornwallis are well maintained and provide a welcoming and warm atmosphere. In the residential part of the home there are two main lounges, one on the ground floor and one on the first floor, and a large ground floor dining room. There is also one lounge/dining room in the nursing wing. There are other smaller areas for use by residents, including two small conservatories, where they can sit on their own or in a small group. There are Cornwallis Court Residential And Nursing Home DS0000024366.V335284.R01.S.doc Version 5.2 Page 19 a number of kitchenettes for use by residents and their relatives to make hot drinks and snacks. There is also small shop and hairdressing salon. Residents had been consulted about the style and colour of new carpets in communal areas. Geoffrey Dicker House is a small single storey building at the back of the main Cornwallis Court building. It has a lounge, dining room, kitchenette, sluice, bathing and toilet facilities and its own self-contained garden. It was noted that some paintwork was needed due to wear and tear and plastic attached to some of the bedroom walls looked unsightly (a historic reason for this was given). We also discussed the approach the home had taken regarding a resident’s behaviour, which had resulted in their chest of drawers was kept in a hallway accessible to other residents and visitors The home had a range of aids, adaptations and equipment designed to meet the needs of residents and assist them with mobility and personal care. There are sufficient bathrooms with adapted facilities. All bedrooms had an en-suite facility. The majority of residents felt that the home is “always” or “usually” fresh and clean. Despite this, there was some concern that no domestic staff are on duty from lunchtime on Friday until Monday morning. One person commented that “During the week its fresh and clean, but no cleaners over the weekend so it is not so clean and fresh.” Another said it was “always” fresh and clean when “there are enough staff on”. A relatives survey commented “we would welcome the home making provision for cleaning of rooms at the weekend”. Staff commented that they had fed back concerns about the build up of rubbish and cleaning to managers but no action had been taken. Examples of areas that residents/relatives and staff felt needed cleaning over the weekend included emptying bins and cleaning toilets and bathrooms. The management team said that during the weekend period care staff would deal with any urgent cleaning needs. We discussed the impact this might have on the time spent with residents and infection control, especially in the nursing wing where residents are usually more dependent with higher needs. (Also see section called Staffing). We also discussed the reasons why there were no domestic staff over the weekend and why/if the service the home offers should be any different on a Saturday and Sunday. An outside company had completed a Fire Risk Assessment for the home. The homes Fire Safety Log had areas where action is needed within 3 and 6 months. This includes free flowing door closures in Geoffrey Dicker House and further information on evacuation procedures for people living at the home with sensory loss. It was noted that the main dining room fire door was being wedged open, as it did not have a self-closure fitted. The maintenance team keep records of safety checks and certificates available for inspection (see section Management and Administration). Cornwallis Court Residential And Nursing Home DS0000024366.V335284.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is adequate. Overall people living at Cornwallis Court can expect staff to have the skills and experience to provide their care. However, they cannot be assured that they will always receive a consistent service or that recruitment procedures will leave them fully safeguarded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The homes pre inspection questionnaire states that the home has nineteen first level nurses, seventy-one members of care staff and twenty-seven domestic staff (including bank staff). Care staff with a National Vocational Qualification at Level 2 or above exceed the workforce-training target of 50 . By increasing its own staffing the home has only needed to use agency staff once in the six weeks leading up to the inspection. The management team discussed the roles and responsibilities of staff and the impact of residents being admitted to the home with higher care needs. People living in the residential area of the home are assessed into three “Bands” - Band 1(lowest needs) to Band 3 (higher needs). They said they have seen a significant increase in Band 3, which has had an impact for staff. It was confirmed that the CSCI do not recommend levels of staffing, rather the home needs to evidence that it has enough staff to meet the needs of the residents living there. The impact on care staff at weekends from not having domestic staff on duty was discussed (see the previous section Environment) along with Cornwallis Court Residential And Nursing Home DS0000024366.V335284.R01.S.doc Version 5.2 Page 21 the nurse’s responsibilities in the home at night and when they are required to leave the nursing wing to administer controlled medication or respond to emergencies (see section Health and Personal Care). Managers also recognised that there is no activities coordinator at the weekend so staff should be more involved with residents social needs over the weekend period. Twelve out of nineteen staff who returned a survey felt that staffing levels on each shift did not give them enough time to meet the assessed needs of residents. A further four surveys said there was enough staff but this could depend on the skill mix on each shift. Some residents felt that they waited too long for staff to answer their call bell. The home provided a print out of all call alarms (which showed the amount of time staff took to respond) over oneweek period. Two days were randomly selected and looked at. There were several occasions noted when it was over 10 minutes before a bell was answered (8 on one day, 6 on another). These were mainly during the morning. There were 8 occasions noted when the response time was 15 minutes or over. The longest response time noted was 36 minutes. In addition there are patterns where call bells are rung and reset frequently within a short period, which may indicate a need to review the level of assistance needed. It was evidenced that the information from this system could not be accessed and changed by anyone at the home, which had been suggested by two people during the inspection. Prior to this inspection, CSCI was made aware that the home did not have a nurse on duty one night and the organisation was asked to investigate this situation. As noted in section Complaints and Protection the outcome of this was not available at the home. The home has its own training coordinator and operates a system called “Care Passports”. Generally staff spoken with and those who returned a questionnaire said they had attended induction training and had regular updates in moving and handling, first aid, health and safety etc. Training files and the homes training plan confirmed this. Staff highlighted that some residents had challenging behaviours and they wanted more training in this area. Comments included: “training at Cornwallis Court is quite good but not enough.” “…due to residents needs (being) so varied we do not receive adequate training on their needs” “I need more training on dementia and how to deal with residents who are aggressive”. All three of the health care professionals who returned a survey answered differently to the question “Do the care staff have the right skills and experience to support individual’s social and health care needs?” answering “Always”, “Usually and “Sometimes”. One commented; “I think overall their skills are at the right pitch” Cornwallis Court Residential And Nursing Home DS0000024366.V335284.R01.S.doc Version 5.2 Page 22 Staff responsible for supervision confirmed they discuss training needs and performance. However they do not have any supernumery time for this. They and the carer are “off the floor” during their meeting. There is no supernumery time for paperwork including care planning and assessment review. As noted in the section Health and Personal Care the nurse on shift leaves the nursing wing to administer controlled drugs in other areas of the home. In turn a member of staff from residential area and Geoffrey Dicker House leave their wings to collect the medication and witness its administration along side the nurse. The files of three new employees were looked at during the inspection. They were well organised into sections called Training and Development, Supervision and Appraisal, General and Recruitment. All three had gaps in work history. One did not have a reference from their last employer another did not have a reference from their last care position. It was discussed with the management team that these elements are needed to safeguard residents from anyone unsuitable. All three applications did have an enhanced CRB Disclosure prior to working their first shift. Comments about staff from residents and visitors/relatives were generally very positive. It was observed that a staff member asked permission to pick some flowers from the garden for a resident who enjoyed looking at them from their window. Other residents picked out staff (including domestic and kitchen) they got on with and enjoyed talking with. Examples included: “most staff are very good, some are excellent” “As a relative of a resident I am always met with a smile by staff and other residents. I can ask a care worker/manager for information and they call and give a positive answer immediately”. Cornwallis Court Residential And Nursing Home DS0000024366.V335284.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): 31, 32, 33, 35 & 38. Quality in this outcome area is good. Overall residents can expect the home to give their needs a high priority, however general staff moral at the home needs to improve to ensure that resident’s experience of the home doesn’t falter and confidence isn’t lost. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager has been in post since 2004 and has the Registered Managers Award and D32 and D33. The Deputy Manager a Registered Nurse level 1. The management team were aware that a recent unannounced visit from the registered provider following a complaint, and other personnel issues had Cornwallis Court Residential And Nursing Home DS0000024366.V335284.R01.S.doc Version 5.2 Page 24 affected the morale of staff. They were keen to alleviate peoples concerns and try to regain confidence for all those living and working at the home. Twelve out of the nineteen staff surveys raised concern about lack of support from management. During the inspection some staff commented that they attended meetings and raised concerns directly but felt that “our opinion doesn’t matter”. The majority of feedback from residents was positive about the home, although two commented that the felt concerns had not been fully addressed. Staff and managers were all clear that their priority was meeting the needs of residents. Care staff were positive about ensuring that residents needs are met and that they are given choices. As noted in previous sections of this report the home has resident led committees in key areas such as catering and activities. Minutes of residents meetings are displayed on notice boards throughout the home as well as general information about the home and the RMBI. The registered provider regularly submits regulation 26 reports to the CSCI reporting on the unannounced visits to the home and their findings. The home also has an audit process that is completed at least annually. The home holds some money for residents in non-interest bearing accounts. The procedures and checks on this were discussed and records produced which evidenced that the accounts balanced. Each resident has a clear record of money in and out. Where a resident had paid a lump sum in advance of care received the Registered Provider was able to evidence how this had been managed. However it was noted that there was no policy and procedure for this situation. The home has a Head of Maintenance who works full time hours and who is assisted by another full time member of staff. They were able to evidence that they kept well-organised records and certificates relating to health and safety, including checks on hoists, boiler, PAT testing and water temperatures. There were also records of tests for emergency lighting, fire alarms and fire drills. We also discussed the requirements of the homes latest Fire Service inspection and when its requirements and recommendations would be put in place (see section Environment) Cornwallis Court Residential And Nursing Home DS0000024366.V335284.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 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 3 3 X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 3 3 3 X 2 Cornwallis Court Residential And Nursing Home DS0000024366.V335284.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 OP15 OP14 Regulation 16 (2)(i) 12(2) Requirement The home must ensure that more dependent residents are consulted about their food and mealtimes. This is needed to ensure that residents’ independence is promoted and their choices are respected. The home must ensure that controlled medication is transported around the home safely to protect residents and staff from potential harm. When prescribed creams are administered this must be recorded on the MAR sheet, to evidence that residents health care needs are being met. The registered provider must provide the CSCI with the outcome of the complaint forwarded to them on the 18th April 2007. The home must ensure that records of recruitment include all the required elements in order to safeguard residents. There must be enough staff on duty to evidence that the home can consistently meet the health DS0000024366.V335284.R01.S.doc Timescale for action 01/08/07 2. OP9 OP38 13 15/07/07 3. OP9 13(2) 15/07/07 4. OP16 22 15/07/07 5 OP18 OP29 19 Schedule2 18 15/07/07 6 OP27 OP38 OP26 31/08/07 Cornwallis Court Residential And Nursing Home Version 5.2 Page 27 8 OP19 OP38 12, 13, 23. and welfare needs of residents at all times. This includes care and domestic staff. The home must evidence that 31/07/07 requirements and recommendations from the Fire Reform Fire Safety Order visit are being addressed within timescales required. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP27 OP9 Good Practice Recommendations The home should clarify the role and responsibilities of the nurse on duty with regard to residents outside the nursing wing. The home should review the homes policy and procedure regarding the administration of controlled drugs to ensure that the health safety and welfare of residents and staff is safeguarded The home should consider how less able residents can be engaged in daily activities and/or consulted about their experience of meals and mealtime. The home should review what it considers a complaint to be and when this is recorded. This would allow the home to address minor issues as they arise, track any trends and give residents and/or their representatives’ and staff confidence that they are being listened to and issues have been addressed. The outcome of complaints should be provided to those involved as soon as possible. This would reassure residents and staff that appropriate action is being taken. The service should ensure that time required to complete supervision, domestic tasks and some record keeping does not impact the level of staff required to meet resident’s needs. The home may which to consider introducing some supernumery hours to complete such tasks. A policy and procedure should be developed for residents who which to pay a lump sum in advance of care received. This will ensure that the home operates in an open way DS0000024366.V335284.R01.S.doc Version 5.2 Page 28 3 4 OP15 OP16 5 6 OP16 OP27 7 OP35 Cornwallis Court Residential And Nursing Home and the residents position is clear. Cornwallis Court Residential And Nursing Home DS0000024366.V335284.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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.V335284.R01.S.doc Version 5.2 Page 30 - 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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