Inspection on 14/05/07 for Cow Lees Nursing Home

This inspection was carried out on 14th May 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cow Lees Nursing Home 24/09/08

Cow Lees Nursing Home 15/05/06

Cow Lees Nursing Home 22/11/05

Cow Lees Nursing Home 01/07/05

Cow Lees Nursing Home 29/09/04

Cow Lees Nursing Home 20/04/04

Similar services:

Coton Hill House

Doddington Lodge

Far Croft

Churchill House Nursing and Residential Home

Field Farm House

Church Terrace Nursing & Residential Home

Fountain Court

The Forbury

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Cow Lees Nursing Home Astley Lane Bedworth Warwickshire CV12 0NF Lead Inspector Jackie Howe Unannounced Inspection 14th May 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cow Lees Nursing Home DS0000004391.V338956.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. Cow Lees Nursing Home DS0000004391.V338956.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cow Lees Nursing Home Address Astley Lane Bedworth Warwickshire CV12 0NF 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) 02476 313794 02476 316750 cowleescarehome@yahoo.co.uk Mr John O`Sullivan Mrs Carole O`Sullivan Margaret Bailey Care Home 52 Category(ies) of Dementia - over 65 years of age (52) registration, with number of places Cow Lees Nursing Home DS0000004391.V338956.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Cow Lees may, within its existing places, care for the named person in the application for variation dated 12 July 2006 15th May 2006 Date of last inspection Brief Description of the Service: Cow Lees Nursing Home is registered to provide accommodation to 52 elderly residents with dementia who may require nursing care. There is currently one resident living at the home who is younger than the specified age, for whom the home has a variation of registration agreed. The home is situated approximately 2 miles from Bedworth town centre in a rural location and offers panoramic views over the countryside. The location of the home does not offer easy access to local shops, local transport services and other community amenities. The accommodation is provided in two main care areas, Cow Lees House and Astley House a new purpose built facility with single en-suite accommodation. of 24 beds which was added 4 years ago. The buildings are not structurally connected. Accommodation in Cow Lees House is provided in mainly shared rooms. Off road parking is provided at the front of the home in an allocated space. Access to all care areas is via passenger lift/stairs. A number of rooms in Cow Lees have limited access; residents occupying these must be able to negotiate small flights of stairs. Gardens areas are easily accessible to all residents; garden areas are mature and well maintained. Information about the home is available in the home’s ‘Statement of Purpose’ and the ‘Service Users Guide’. The current scale of charges is £ 465 - £520 per week. Additional charges are made for chiropody and hairdressing. Cow Lees Nursing Home DS0000004391.V338956.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first inspection of the inspection year 2007/08 and was unannounced. It was undertaken over a period of one day, and was carried out between the hours of 09:30 am and 5:00 pm. The pharmacist inspector also visited the home on 10th May and the outcomes of her inspection have been included in this report. The inspection focused on the outcome for residents of life in the home. The manager supplied the commission with a Pre inspection Questionnaire (PIQ). A number of survey questionnaire forms were sent to the home to be completed by residents and relatives but only two were returned. Information from these has been used to make judgements about the service, and has been included in this report. The inspection process reviews the home’s ability to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision where improvements may be required. During the inspection, the care of three residents who live in the home was examined in detail. This included reading assessments, care plans and other documentation, observing care offered to them and that staff have the necessary skills to care for them. This is part of a process known as ‘case tracking’ where evidence is matched to outcomes for residents. Records including staff files, policies and procedures, health and safety / environmental checks and risk assessments were also read. The home’s registered manager was present through out the day, and the inspector was able to tour the home, and spend time speaking with residents, and staff. The inspector ate lunch with the residents in the dining room on the top floor of Astley House, and was able to observe care practices, and how staff interacted with residents in the home. The inspector would like to thank the manager, staff and residents for their cooperation and hospitality. What the service does well: Prospective residents receive an assessment of needs prior to entering the home, so that they can assure residents and their relatives that their needs can be met. Cow Lees Nursing Home DS0000004391.V338956.R01.S.doc Version 5.2 Page 6 Health care needs are met, with residents having access to GP, chiropody, optician, dentist and a consultant psycho-geriatrician The home is managed by an experienced management team, who are well qualified and understand the needs of people using this service. Relatives feel confident in their ability to manage. It was noted during the inspection that the manager spent time out around the home, and took action in response to comments made. The home has a happy atmosphere, and staff were noted during the inspection to speak with residents in a warm and courteous way. The home has a consistent staff team, and does not use agency staff in the home, thus providing continuity of care. Staff have a good knowledge of the residents. One survey returned said the following about the staff. ‘They get to know the residents needs, likes and dislikes and make sure that they are as happy as can be’. Relatives and friends were seen coming and going from the home and appeared comfortable and welcomed. What has improved since the last inspection? What they could do better: Further work is required in the medicine management, to ensure that all the people who live in the homes needs are fully met. Cow Lees Nursing Home DS0000004391.V338956.R01.S.doc Version 5.2 Page 7 An appropriate quality assurance system needs to be established to ensure that the home is running in the best interests of service users. Currently input from those using the services is limited. The environment in Cow Lees House, the older part of the home, is in need of refurbishment and modernisation. Some of the bedrooms and corridors are dark and uninviting and in stark contrast to the other house. One of the surveys returned reflected this: ‘It would help if all the rooms were modernised with en-suite facilities’. The environment in Astley House, is new, clean and the furnishings are of good quality, however some of the rooms, particularly communal areas and dining rooms, are rather bland and could be more homely to provide a more relaxing atmosphere for the residents. The laundry is in need of refurbishment and modernisation to provide a clean, hygienic environment. The manager said this need had already been identified and plans for refurbishment were being discussed. Records kept about complaints made, should be improved to demonstrate whether a complaint has been upheld, and what actions the management team has undertaken to investigate complaints. 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. Cow Lees Nursing Home DS0000004391.V338956.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 Cow Lees Nursing Home DS0000004391.V338956.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): Standards 1, 3 and 6 Quality in this outcome area is good. Prospective residents are assessed prior to moving into the home and given assurances that their needs can be met by the home. The home does not offer intermediate care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The ‘Service Users Guide’ is kept in the office and the manager said that it was shown to residents and their families as part of the admission processes. The folder includes a copy of report following the last inspection by the commission. One relative spoken with said that she could not recall seeing any written information about the home, but found the manager and staff helpful through the admission process. Cow Lees Nursing Home DS0000004391.V338956.R01.S.doc Version 5.2 Page 10 The Service Users Guide, does not indicate when it was last reviewed, and some of the information contained is out of date. This document should be reviewed regularly to ensure that it is always providing prospective residents with up to date relevant information. It is recommended that the date of the last review be included on the front cover of the document. The pre admission assessment for a resident recently admitted to the home was read. The assessment showed that the home had looked at the specific needs of the resident, and had undertaken an assessment in the key risk areas of: nutrition, safety, risk of falls and tissue viability. As the home is specifically offering care to residents with a diagnosis of dementia, the home also undertakes some assessment of memory, and specific needs related to their diagnosis. A care plan had been started for this resident, but did not yet contain specific information related to personal identified needs, or life history information. Information about the resident had been received from other health care professionals, involved in the care. A pro forma letter that the home uses to inform residents or their families that the home can meet their needs was seen. One family member said that she was informed by telephone, and appreciated that this was done promptly so that arrangements could be made. Cow Lees Nursing Home DS0000004391.V338956.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): Standards 7, 8, 9 and 10 Quality in this outcome area is adequate. Care plans have been improved, but more detail is required to show that these reflect individual needs, and demonstrate that all health care and other needs are being met. Policies and Procedures for medicine management are not always safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans of three residents were read and their care ‘tracked’ during the inspection. Reasons for choosing these residents was due to either specific needs, changes in condition or to follow up on information received prior to the inspection. Since the last inspection, the manager and the staff have undertaken a full review of the care plans, and have included risk assessments to identify where a resident may be at specific risk, to identify measures the home needs to undertake to minimise those risks, and to guide staff as to what care to give to Cow Lees Nursing Home DS0000004391.V338956.R01.S.doc Version 5.2 Page 12 residents. Measurements of weight had been taken on a monthly basis and were recorded, however the weight chart was at the front of the care plan, not linked to the information and plan of care related to nutrition and diet, which could result in a care plan not being accurately updated. One care plan read, had been reviewed following the resident sustaining a fracture and the care needs amended. It was evident from the care plans read that areas identified for improvement at the last inspection, had been achieved. Language used in care plans was sensitive and showed some understanding of the very specific needs of people with a dementia. There is however further need for improvement. Care plans do not fully reflect persons’ individual needs, to ensure that they are receiving care, that reflects their retained abilities and is offered in a way they prefer. Plans do not identify in detail how a person likes their personal care to be given, or what they are still able to do for themselves and where appropriate, examples of positive risk taking. Life history information was contained in one care plan, but it was tucked right at the back, and not easily found. The information contained, gave staff a clear indication of the person’s previous lifestyle choices and likes and dislikes, but none of this had transferred into the care plan, for example a love of plants and flowers, so that the activity programme could reflect this interest. One care plan read, did not adequately demonstrate the reasons why a significant change in care practice was taking place and what the reasons were for the change. There was evidence of residents having access to GP, chiropody, optician, dentist and consultant psycho-geriatrician, but recording was not always complete. One care plan showed that a referral was to be made to a dermatologist, but there was no information to say if this had taken place. Another mentioned a need to contact a community psychiatric nurse (CPN) for a review, but again no outcome was recorded. Staff were observed to address service users by their preferred names and were respectful of their rights to privacy and dignity when attending to their care needs. One relative commented that ‘ They always dress him nicely and match him up’. There was however evidence that residents are not wearing their own socks, tights and stockings, and there was a lot of clothing in the laundry sorting room that was unnamed. The manager said that some of this had been donated to the home. Cow Lees Nursing Home DS0000004391.V338956.R01.S.doc Version 5.2 Page 13 The manager said that a number of residents did not have relatives to supply clothing, particularly tights, so the home purchased and supplied them instead. Whilst this is commendable and it was clear that residents on the day of the inspection were well dressed, the dignity of being able to wear named personal items should be addressed. The pharmacist inspector visited the home separately from the lead inspector. A random selection of medicine charts, their corresponding medicines and daily records and care plans were looked at. Staff were interviewed and all feedback was given to the manager on duty at the time of the inspection. The home has reviewed the medication policies and procedures. These had improved but failed to address a few details, which were fed back to the manager. Audits undertaken to see if the medicines had been administered as prescribed, indicated that the majority of medicines had and records reflected practice. Daily records supported any dose change and care plans supported the medication prescribed in most instances. Medication reviews are undertaken for all new people who come to live in the home and regular medication reviews are also sought which is commended. A quality assurance system has been implemented to assess whether nursing staff administer medicines and accurately record the transaction. These occur at present monthly. Medicines stored in the medication room in the original part of the home were not stored in compliance with their product licence and their stability could not be guaranteed, as the temperature was too hot to safely store them within. This was raised at the last pharmacist inspection. A system has been installed to check the prescriptions prior to dispensing and to check the dispensed medicines and medicine charts received into the home. Staff did not always adhere to this system as the doctor had changed one dose regime for one person who lived in the home and the old dose regime was administered. Staff had failed to identify this and the person did not have any of the newly prescribed medicines. A further error was seen where the doctor had prescribed one medicine and the pharmacist had recorded he had dispensed the generic form which may be detrimental to the well being of the person concerned for that particular medicine. The homes checking in procedure had failed to identify this discrepancy. One nurse interviewed during the inspection had a good understanding of the medicines she administered. Cow Lees Nursing Home DS0000004391.V338956.R01.S.doc Version 5.2 Page 14 A couple of medicines had run out and nursing staff had failed to get a supply on time to ensure a continuous supply as the doctor intended. This was due to reliance on the resident’s spouse to bring in further supplies instead of the nurses obtaining a new supply for new residents who had come to live in the home. All controlled drug balances were correct and medicines were correctly stored. There were no current medical information textbooks for the nurses to refer to for current drug information. Cow Lees Nursing Home DS0000004391.V338956.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All of the above standards were assessed at this inspection. Quality in this outcome area is adequate. The home employs staff to put in place a programme of activities, which goes someway to providing service users with a life style, which reflects their personal choices and interests. Provision of food has improved and the value of good nutrition is seen as important, although the atmosphere of the dining rooms does not promote a pleasant dining experience. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs an activities co-ordinator three times a week, and one of the owners also comes in most days to help with activities. Activities available to residents include: hairdressing and hand massage, sing a longs, skittles, board games, darts and simple quizzes. Church services are available monthly in alternate houses, although residents are able to join in either one. The home uses the mini bus and taxis to organise trips out which includes, a visit to Bedworth civic hall to old time music events. There are photographs of trips undertaken on the notice board. Cow Lees Nursing Home DS0000004391.V338956.R01.S.doc Version 5.2 Page 16 On the day of the inspection there were activities noted to take place in both houses, although it was more evident in Cow Lees house where the atmosphere was livelier. Staff were observed to sit with residents, and look at books, and give a hand massage. Some residents were noted to sit with a doll that offered them comfort. In Astley House, there was less taking place, and little on display for residents to access independently, or spontaneously. Games and balls were available, but were tucked tidily away in baskets in a dresser. The manager said that a few of the residents could access these independently themselves. Some of the gentleman in Astley house, who were physically fit, were walking the corridors and were not involved in any meaningful activity. There was nothing taking place to involve them, although the manager said that one gentleman on a good day liked to ‘tinker’ with the tractor, and enjoyed looking and talking about the farm and chickens kept in the grounds. One resident likes moving the furniture, piling it up against the wall. Staff discreetly put this back and did not prevent him from doing this. One relative spoken with said that she took her husband out into the grounds, but he had not been on any of the trips. She said that she was warmly welcomed into the home and was included in all decisions made about his care . She was particularly pleased that she was kept informed. ‘They never do anything without discussing it with me first’. The inspector ate lunch with residents on the top floor of Astley House. Twelve residents live in this unit, and there were three staff on duty, one offering a one to one service to a resident who required assistance to eat. Lunchtime was fairly busy, but staff did not appear rushed, or rush residents with their food. A number of residents required support and prompting, some residents required more intervention than others. Staff offered assistance sensitively, and made sure that residents had enough to eat. A number of residents required a softened diet, and one of the residents case tracked during the inspection was observed. Soft diets were served with different food groups kept separate to allow the resident to taste the individual foods. There was no visible menu available, but staff reminded residents what they had chosen. The menu on the day of the inspection was: Steak pie or fish cakes, served with mashed potatoes, swede and broccoli. Desert was cheesecake or fruit and ice cream. Some residents were not offered a choice or reminded that this choice was available. The meal was Cow Lees Nursing Home DS0000004391.V338956.R01.S.doc Version 5.2 Page 17 served hot and was tasty. Residents enjoyed their meal with one stating ‘The food here is superior’. It was noted that meals were served with gravy already added, but the parsley sauce for the fish cakes was offered separately allowing residents’ to choose if they wanted it. The manager said that a picture menu was available to help residents make a choice of food, and that offering a visual choice of food was also encouraged, although this was not observed to take place on the day of the inspection. The dining room is a large room, bright but plainly decorated with one picture on the wall, and a small kitchenette area in the corner. There is nothing on display to make it homely, or prompts such as pictures of food, to remind residents that it is a dining area, which is appropriate for the needs of residents with a dementia. The dining tables are serviceable and can be wiped clean. There were no tablecloths or table mats, although salt and pepper and napkins were available. The manager said that cloths and mats were not used as they were not practical due to some behaviours displayed. On the day of the inspection and in this dining room, the residents did not demonstrate behaviours that would constitute a problem, and items like this would enhance the general appearance of the room and may make mealtimes more of an event. Staff spoken with said that they did not sit and join residents for a meal. It is thought to be good practice in dementia care, for staff to sit with residents and join them for a meal, so that visual prompts can be made in relation to reminding residents how to use cutlery etc. This was discussed with the manager, who said that this was something she would like to introduce. Cow Lees Nursing Home DS0000004391.V338956.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is adequate. Service users and their relatives are confident that their concerns are listened to, although records to demonstrate outcomes of complaints could be improved. Policies and procedures in place should protect residents from potential abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure, and this is displayed as well as being available in the ‘Service Users Guide’. The procedure needs updating along with the rest of the guide, to reflect changes in contact numbers and addresses. The procedure is not currently available in a variety of formats, to meet individual needs of residents in the home. One relative spoken with said that she had not seen the procedure, but knew who to go to should she need to do so. She said that she found the managers and staff to be ‘understanding and caring’. The manager said that she had not received any complaints. The commission has received two complaints about the service since the last key inspection. These complaints were assessed in detail at a ‘random’ inspection in February Cow Lees Nursing Home DS0000004391.V338956.R01.S.doc Version 5.2 Page 19 2007, and some requirements were made as a result, for the home to improve the service. These issues were regarding: • • • • The safe management of medicines The quality of the evening meal The environment Staffing levels All of these areas were again reviewed at this inspection and the outcomes referred to in relevant areas of the report. The manager keeps a complaints file. There was only one complaint in the file, which contained the response that the manager had made to the commission, regarding the complaint. There was no information available about how the manager had investigated the complaint or the outcomes, for example, if the complaint had been upheld, or if the complainant was satisfied with the response. This should be included in the records maintained and used as part of a general quality assurance audit for the home. There is also no record kept of minor concerns or comments made. The manager said that she would deal with most concerns on a one to one basis, and issues raised with staff were normally recorded in care files / daily records. It was noted during the inspection that the manager spent time out around the home, and took action in response to comments made. Since the last key inspection, the home has had to refer one member of staff using the Protection of Vulnerable Adults (POVA) procedures. The management team in the home handled this effectively using the correct policies and procedures. The home has policies and procedures in place to recognise and respond to allegations of abuse, and has a copy of the Warwickshire multi agency policy for responding to abuse. Records seen for training undertaken by staff were not clear as to when POVA training last took place. The manager said that she had now received the workbooks from the Warwickshire skills base, and also a training video, which she was planning to show to the staff as an additional training tool. One member of staff spoken with said that she had attended a POVA course, and was aware of the ‘whistle blowing’ policy; another said she had not attended a course, but now had the workbook. Cow Lees Nursing Home DS0000004391.V338956.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 24 and 26 Quality in this outcome area is adequate. Areas of the home are in need of redecoration and refurbishment to consistently offer residents an environment, which is safe, homely, comfortable and promotes independence and positive risk taking. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the home was undertaken with the manager. The inspector was able to go into all areas of the home, including personal rooms and all communal areas and the gardens. Accommodation in the home is provided in two separate buildings. Cow Lees house is a converted building and Astley House is a purpose built extension completed almost 4 years ago. The home has an ongoing plan of maintenance and refurbishment. Cow Lees Nursing Home DS0000004391.V338956.R01.S.doc Version 5.2 Page 21 The two buildings are in complete contrast to each other. Cow Lees house is a much older building, providing accommodation in primarily shared rooms with only one room having en-suite facilities. There are two lounges, one called the music room, a large entrance hall where residents are also able to sit and watch the comings and goings from the home, and a large dining room. Some residents choose to eat their meals in the music room, as this area is quieter. The dining room at Cow Lees was assessed at the random inspection undertaken in February, in response to a complaint, and a requirement was made to improve the environment. The dining room was found to be ‘sparse, basic and functional’ creating an ‘uninviting atmosphere for residents to eat in’. The manager confirmed that no changes had as yet been made to improve this environment, but that the dining room would be improved as a part of the general refurbishment planned for the home. Whilst it is acknowledged that this is planned, intermediate measures for improvement must be introduced, and the manager should consider ways that the presentation of the dining tables and the room could enhance the environment. The kitchen area was clean and in good order and safe working practice was observed. The home was previously inspected by the environmental health department and work required actioned. The laundry is housed in outbuildings and separate laundry staff deal with most of the washing, although this is the responsibility of the care staff in the evening. On the day of the inspection, one of the washing machines was out of order, and some of the washing waiting to go in to the machine was on the floor. This is poor practice and could provide a risk of cross infection. Astley house as previously mentioned is a modern purpose built house, providing spacious accommodation with en-suite bedrooms. There is a conservatory on the ground floor. This house was well decorated, with good quality furnishings. Bedrooms are well furnished and personalised to taste. Bedroom doors have personal names on the door, although some are placed rather high on the doorframe, which makes them difficult to read and the numbers on many of the doors were not present. The inspector was told that this was because a resident removed them. The bedroom doors on the ground floor are currently locked, due to the behaviour of one resident on the floor. Residents’ families have been given keys so that they are free to enter the room and residents who wish to go to their room, are let in by staff. One relative spoken with said that she was happy with this practice, as she preferred to keep the room private and the possessions safe. Cow Lees Nursing Home DS0000004391.V338956.R01.S.doc Version 5.2 Page 22 The manager should consider the impact on residents, that not being able to freely enter and identify their own rooms may have on their well being, and put in place permanent door numbers and name plates that cannot be removed. Residents with a dementia often like to walk about and require prompts to assist them in finding their own space. This must be reflected in individual care plans. Communal areas in the house, whilst well decorated are rather bare, especially the dining rooms which would benefit from some additional fixtures and fittings, and prompts to remind residents where they are. In the interests of safety and to protect residents who are vulnerable, all the doors to stairs and outside areas are secured using a keypad system. One door in Cow Lees house currently is not secure, but the manager is taking action to deal with this. Residents are able to enjoy views of the gardens, which are very well maintained but not secure. Residents are unable to access the outside independently. On the day of the inspection the weather was not good enough for people to go outside. The manager said that residents do make good use of the garden areas, and there are items of interest such as a tractor and attractive planting. The rear of the home is open to the road, and the paving is uneven in places causing a potential trip hazard. Cow Lees Nursing Home DS0000004391.V338956.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All the above standards were assessed at this inspection. Quality in this outcome area is adequate. Staffing levels in the home and training offered to the staff group ensure that residents receive care, by staff who have the required skills to meet their needs. Recruitment procedures are generally safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing in the home was reviewed in detail at the random inspection undertaken in February, and the situation regarding staffing remains unchanged. There are still a number of residents who are receiving care at times during the day on a ‘one to one’ level. Staff rotas whilst held individually for each house, are used flexibly to place staff where the need is required. Currently the duty rota shows staff working in the home as E or L to denote an early or a late shift. This must be a true reflection of the hours worked by staff i.e. 8am – 2pm, so that an assessment can be made that this is suitable and appropriate to the needs of the home at any one time. On the day of the inspection there appeared to be sufficient staff available to meet the needs of the residents in a calm, unrushed way. The attitude of staff was friendly and demonstrated true caring for the residents in the home. Cow Lees Nursing Home DS0000004391.V338956.R01.S.doc Version 5.2 Page 24 The home does not use agency staff but instead makes good use of its own ‘bank’ of staff which employs people who are able to work flexibly to cover vacancies caused by annual leave and sickness. This should ensure a more consistent staff group. Since the last inspection, there a high turnover of staff, and information provided by the home prior to the inspection show that 17 staff have left employment since the last inspection. The home has managed to newly recruit a number of qualified nurses who were at the home on placement as a student, and at the time of the inspection two student nurses from Coventry University, were currently on a placement at the home. The manager said that the students were always supernumerary to the established staff rota. Relatives spoken with spoke highly of the staff and their care for the residents in the home. ‘ The staff do care for him really, really well’. ‘ I have no worries as to the way……… is looked after’. One survey received indicated that there was at times insufficient staffing. ‘It would help if they had more staff so that they could give individuals more attention’. Training records were not sent with the Pre inspection Questionnaire, and records available for inspection were limited. Files seen showed that staff are able to attend training courses which include mandatory training courses that focus on residents safety and it was evident that staff had attended recent training in Health and safety and Manual Handling. Fire training had been attended last year. The training matrix was not available during the inspection, and so it was not possible to see how many staff had or had not attended. One file read showed that one member of staff had attained a national Vocational Qualification (NVQ) at level 2 in care, and had attended training in manual handling techniques, wound care, dementia care and fire safety. She had not attended training in health and safety or basic food hygiene, but had covered first aid as part of her NVQ. She had also been given a copy of the POVA workbook. The registered manager is a trainer in dementia care, and undertakes a specialist training course, accredited by the Alzheimer’s society with all the staff in the home. Cow Lees Nursing Home DS0000004391.V338956.R01.S.doc Version 5.2 Page 25 In response to requirements previously made by the commission, the home has improved the number of staff attaining an NVQ and a further five staff were enrolled in September 2006. The manager and her deputy have also improved the induction process for new staff to the home. One member of the nursing staff newly recruited to the home said that she was currently working through the induction pack with her line manager. Three staff files were read to check recruitment procedures. Generally these were of a good standard. Appointment was not confirmed prior to necessary safety criminal record checks being undertaken, and staff completed application forms and were recruited via an interview. Evidence of true identity was also seen. These practices safeguard residents. One file read showed that two written references had not been obtained, although recorded verbal references were on the file. To ensure the authenticity of the reference, and therefore safeguard residents in the home it is required that written references are always obtained. Cow Lees Nursing Home DS0000004391.V338956.R01.S.doc Version 5.2 Page 26 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. The home has a competent manager who is well qualified. Systems in place do not demonstrate that the home is being run in the best interests of the service users, nor fully protect the safety of both service users and staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home has been in post for 5 years. She is a registered nurse and has recently completed the Registered Manager’s Award (NVQ 4). The manager and her deputy were able to clearly identify the areas that they felt they had improved and developed, and where they felt more improvement was required. Both demonstrated a good knowledge of the needs of residents in the home and requirements for standards as defined in the National Cow Lees Nursing Home DS0000004391.V338956.R01.S.doc Version 5.2 Page 27 Minimum Standards. Staff spoken with said that the management team were helpful and supportive. The manager said that she had regular meetings with the owners, and felt able to make requests on budget and expenditure where required. The owners of the home are often on the premises, undertaking maintenance, and activities. The manager identified that one of the areas in need of improvement was Quality Assurance. A system has been devised, but not fully implemented and there is nothing to demonstrate what the home has done in response any to information obtained. There was very little response to the satisfaction surveys sent to the home prior to the inspection from the commission, with only two completed and returned. The manager said that she had attempted to hold meetings for relatives, but had little response. One relative spoken with said that she had completed a survey for the commission, but had never seen one from the home, or been made aware of a meeting. Whilst, as previously reported, the manager spends time around the home and responds to comments made to her, there is no documented evidence to show what these are and what action has been taken in response. The home does not hold personal monies for safekeeping for any of the people living in the home. Bills are produced for additional charges for chiropody and hairdressing and sent to the person appointed to manage the residents’ finances. This is usually a relative, solicitor or the Advocacy services. Evidence was seen in staff files that staff supervision is undertaken with senior staff undertaking the supervision for each of their identified teams. Maintenance of the home is generally undertaken by the owner with outside contractors responsible for the lifts, electrical checks, and specialist equipments such as hoists. Evidence was supplied to the commission that these have all been undertaken within the correct timescales with the hoists being checked in February 2007. Information provided about fire safety was not sufficient to make a full judgement. Records regarding fire training were supplied following the inspection and show that fire training was available in April and September 2006, but not all staff have attended. As the home has had a high turnover of staff, and employs a number of staff on a relief basis, it is particularly important that fire training takes place at suitable and regular intervals. The manager said that the deputy manager was now undertaking fire drills two monthly, but could not find the evidence to support this. The PIQ stated that the fire officer’s last visit was in February 2005. Cow Lees Nursing Home DS0000004391.V338956.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 2 x x x 2 x 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 1 x 3 3 x 2 Cow Lees Nursing Home DS0000004391.V338956.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Care plans must accurately record all changes to personal and health care and reflect more of the persons individual needs in order to demonstrate a ‘person centred’ approach to care. All medicines must be available for administration as the doctor intended. Staff must ensure that prescriptions are checked prior to dispensing and discrepancies appropriately addressed to ensure that the service users receive their medication safely. The home must ensure that all medicines are stored in compliance with their product licenses at all times to guarantee their stability Arrangements for providing an environment where all service users have the opportunity to enjoy their meals in comfort, must be reviewed to improve the quality of life for people living in the home. This requirement was part met. Previous timescale DS0000004391.V338956.R01.S.doc Timescale for action 31/07/07 2. OP9 13(2) 10/06/07 3. OP9 13(2) 10/06/07 4. OP15 12 31/08/07 Cow Lees Nursing Home Version 5.2 Page 30 5. OP26 13 6. OP27 17 7. OP29 19 8. OP33 24,26 9. OP38 12 10. OP38 23 31/03/07 Staff must ensure suitable procedures are always undertaken, to prevent the spread of infection in the home. The duty rota must be a true reflection of the hours worked by staff so that an assessment can be made that this is suitable and appropriate to the needs of the home at any one time. Two written references must be obtained prior to a new member of staff working at the home, to ensure that references received are authentic, and to minimise the risks to service users. There must be a suitable system for reviewing and as required, improving, the quality of services provided in the home so that service users and their relatives can be assured that their views are taken seriously. A review of the risk assessment related to the fire exits and garden areas must be regularly undertaken, so that residents are able to access outside areas independently with due regard to their safety. Adequate precautions must be undertaken against the risk of fire. This must include regular fire safety training and drills for staff and the completion of a fire risk assessment. 31/05/07 30/06/07 31/05/07 31/08/07 31/07/07 31/07/07 Cow Lees Nursing Home DS0000004391.V338956.R01.S.doc Version 5.2 Page 31 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 OP1 Good Practice Recommendations A review date included in the ‘Service Users Guide’ would ensure interested parties that the information was up to date. This should be available in different formats to account for the different needs of service users. The British National Formulary should be purchased for every new edition, so that nursing staff have access to current medicine information. The medication policy should refer to the Mental Capacity Act 2005 when medicines are administered covertly. CSCI should be notified of all errors in drug administration. The practice of sharing tights and stockings should be stopped and a new system introduced to ensure that residents receive their own supply and their dignity is respected. Residents would benefit from the availability of more accessible items to use independently and to enhance more spontaneous daily activity and entertainment. The activity programme should take into consideration the needs of those who have particular needs, and are less able or at risk of being isolated. Wherever possible service users must be offered choice and the opportunity to exercise some control over their lives. This should be demonstrated in a person centred care plan and reviewed regularly to reflect changing needs and abilities. Residents would benefit from staff eating alongside them, where appropriate, to encourage independent eating and retained skills and abilities. Records of complaints received should be improved to include the outcomes of the investigation and actions taken, and if the complaint is upheld or not. More informal records for reporting and responding to comments made about the service should be kept to demonstrate actions taken by the home in response. This would supplement a formal Quality Assurance process. 2. 3. 4. 5. OP9 OP9 OP9 OP10 6. 7. 8. OP12 OP12 OP14 9. 10. 11. OP15 OP16 OP33 Cow Lees Nursing Home DS0000004391.V338956.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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