Inspection on 24/09/08 for Cow Lees Nursing Home

This inspection was carried out on 24th September 2008.

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

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

Other inspections for this house

Cow Lees Nursing Home 14/05/07

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 19/12/2008.

CARE HOMES FOR OLDER PEOPLE Cow Lees Nursing Home Astley Lane Bedworth Warwickshire CV12 0NF Lead Inspector Michelle McCarthy Unannounced Inspection 24th September 2008 10:20 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.V372764.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.V372764.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 (52) registration, with number of places Cow Lees Nursing Home DS0000004391.V372764.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care with nursing and accommodation for service users for both sexes whose primary care needs on admission to the home are within the following category:dementia, DE, 52. The maximum number of service users to be accommodated is 52. 2. Date of last inspection 14th May 2007 Brief Description of the Service: Cow Lees Nursing Home is registered to provide accommodation to 52 older people with dementia nursing care needs. 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 purpose built addition with single en-suite accommodation of 24 beds. 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’. Cow Lees Nursing Home DS0000004391.V372764.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection visit. This is the most thorough type of inspection when we look at all aspects of the service. We concentrated on how well the service performs against the outcomes for the key national minimum standards and how the users experience the service. Before the inspection, we looked at all the information we have about this service, such as information about: • • • concerns, complaints or allegations incidents previous inspections and reports. We do this to see how well the service has performed in the past and how it has improved. The manager completed an Annual Quality Assurance Audit (AQAA) and returned it to us within the timescale required. The visit to the home was made on Wednesday 24th September 2008 between 10.20am and 6.30pm. 46 people were living in the home on the day of our visit. It was the assessment of the home manager that the majority people living in the home had medium to high dependency dementia nursing care needs. We used a range of methods to gather evidence about how well the service meets the needs of people who use it. This included talking to people who use the service and observing their interaction with staff where appropriate. We also looked at the environment and facilities provided and checked records such as care plans and risk assessments. 11 service user survey forms were completed returned to us. Some were completed by residents and some were completed by relatives. Their comments are reflected throughout this report. Four people using the service were identified for case tracking. This is a way of inspecting that helps us to look at services from the point of view some of the people who use them. We track peoples care to see whether the service meets their individual needs. Our assessment of the quality of the service is based on all this information, plus our own observations during our visit. Cow Lees Nursing Home DS0000004391.V372764.R01.S.doc Version 5.2 Page 6 At the end of the visit we discussed our preliminary findings with the home manager. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. What the service does well: What has improved since the last inspection? An air conditioning unit has been installed in the medicines storage room in Cow Lees house and daily room temperature recordings show that medicines are stored within recommended limits to maintain their stability. Residents are safeguarded by robust recruitment procedures. Cow Lees Nursing Home DS0000004391.V372764.R01.S.doc Version 5.2 Page 7 The outside courtyard between the two houses has been made secure since the last inspection so that residents can safely access and make use of this area independently. The service has prepared an updated fire risk assessment for Cow Lees House and Astley House in response to a requirement made by Warwickshire’s Fire Officer following their inspection in July 2008. The manager and home owner keep working practices under review and take action when they identify where improvement is necessary. What they could do better: 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.V372764.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.V372764.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): Standard 3 was assessed. Quality in this outcome area is good. People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We examined the case files of three people admitted to the home since the last inspection to assess the pre-admission assessment process. These residents were included in case tracking. The manager said that it was usual for her or a senior member of the nursing staff to visit people who are considering moving into the home to undertake an assessment of their needs and abilities. Cow Lees Nursing Home DS0000004391.V372764.R01.S.doc Version 5.2 Page 10 Each of the files examined contained information gathered during a preadmission assessment that identified all of the person’s needs. Files also contained pre-admission information provided by professional health and social care agencies and incorporated into care plans. Information gathered about the needs and abilities of people living in the home is used to develop care plans to meet these needs. Cow Lees Nursing Home DS0000004391.V372764.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 were assessed. Quality in this outcome area is good. People living in the home are treated respectfully and are protected from harm by the safe management of medicines. Care plans are available for most of the identified needs of residents and staff recognise and respond to changes in the health and well being of people living in the home. This means that people living in the home can be confident their health and personal care needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living in the home looked cared for and were clean, their hair had been combed and nails were trimmed and clean. They were well presented and wore clothes that were suited to the time of year. It was evident from our observation that the personal care needs of people living in the home are met. Cow Lees Nursing Home DS0000004391.V372764.R01.S.doc Version 5.2 Page 12 Peoples’ comments included, ‘could not ask for better attention form everyone’ and ‘we are happy with the care my relative gets at Cow Lees and we have no complaints. Staff and management are good and willing to help’. The care files of four people identified for case tracking were examined. Care files were standardised and well organised which should mean that staff have good access to information about the needs of people living in the home and the actions they need to take to meet those needs. Each file contained a single sheet detailing people’s lifestyle preferences such as their food preferences and times for getting up and going to bed. For example, one person’s preferences recorded, ‘I like to go to bed between 11pm and 12pm’. This means staff have a quick reference tool to give them information about people’s lifestyle choices. Care plans were available for most of the identified needs of each person and supplied staff with the information needed to make sure these needs were met safely and appropriately. For example, the care plan for one person with variable mobility needs documents, ‘two members of staff are to assist xxxx with all transfers. Use a lifting belt when xxxx is able to weight bear and use a hoist if xxxx is unable to weight bear’. Care plans did not contain sufficient detail about how to meet the needs of some people. For example, the ‘elimination’ care plan for one person with a urinary catheter did not record the date of the last catheter change or the date when the next change was due, although it included information instructing staff to ‘change every 12 weeks’. The wound care plan for a skin tear to one resident’s leg documented that the dressing should be renewed ‘every three to five days’. The last entry in the care plan review records that the dressing was renewed eight days ago. This means we cannot be certain whether the dressing has been renewed as per plan. The service uses risk assessment tools to identify whether residents are at risk of developing pressure sores, poor nutrition or have an increased risk of falls. Each person’s care file contained a record of contact with or visits by Health Care Professionals. These confirmed that people living in the home have access to Health Care professionals such as the GP, dentist, optician and chiropodist. One person’s records showed that staff had made referrals to the GP on several occasions when they observed symptoms of a urinary tract infection so that antibiotic therapy could be prescribed. People are weighed at least monthly as part of monitoring their general health. Most people had maintained or gained weight. Staff referred one person with an identified weight loss to the GP and a food supplement was prescribed. Cow Lees Nursing Home DS0000004391.V372764.R01.S.doc Version 5.2 Page 13 We examined the systems for the management of medicines in the home. A monitored dosage (‘blister packed’) system is used. Medication is safely stored in locked trolleys, which are kept in locked rooms. A medicines fridge is available with daily recordings of the temperature, which is within recommended limits. An air conditioning unit has been installed in the medicines storage room in Cow Lees house and daily room temperature recordings show that medicines are stored within recommended limits to maintain their stability. This complies with a requirement made during the last inspection. Staff do not monitor the temperature of the small rooms where medicine trolleys are stored in Astley House. It is recommended that room temperature records are maintained so staff can be sure that medicines are stored within recommended limits to maintain their stability. The facility for storing controlled drugs (CD) is satisfactory. The contents of the controlled drug cabinet were audited against the controlled drug register and the quantities were correct. Medicine administration records (MAR) were completed correctly. Audits of the medication of the people involved in case tracking were undertaken and were correct indicating that medicines had been administered as prescribed. People living in the home were observed to be treated with respect and their dignity maintained; for example, personal care was provided in private and residents were spoken to respectfully. During observation of working practice it was evident that staff are knowledgeable about the likes and dislikes of people living in the home and were kind, caring and attentive towards them. We observed an incident when one resident started to shout and bang, staff responded quickly to offer calm reassurance, which reduced the person’s agitation and distress. Cow Lees Nursing Home DS0000004391.V372764.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 were assessed. Quality in this outcome area is adequate. There are some opportunities for residents to participate in meaningful activities to enhance their quality of life. Visitors are made welcome to support people’s enduring relationships. Residents benefit from a nutritious and varied diet but they are not always sensitively assisted by staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home owner spends 12 hours each week organising and undertaking residents’ recreational activities. She is supported by an activities organiser, employed for 12 hours a week, Monday to Thursday. An activity programme is planned and includes music, hand massage, quizzes, going outdoors and church services. ‘Life stories’ were completed in the case files of the people we case tracked. These documented people’s life histories, their enduring relationships, family life, employment history and interests. This means staff have good access to Cow Lees Nursing Home DS0000004391.V372764.R01.S.doc Version 5.2 Page 15 information about people’s social, cultural and recreational preferences so they can meet their needs. The atmosphere in Cow Lees House was cheerful and welcoming. This older part of the building provides a choice of homely and cosy communal areas. We observed residents engaging with staff as well as each other. Astley House was more subdued and less interaction was observed. Residents can choose to use the lounges or dining rooms, both of which are pleasant, but functional. No one was using the conservatory area on the day of our visit. People’s comments included, ‘my relative tries to stay out of activities but the staff always try to include him’, ‘when I have visited, I have never seen activities on the floor my relative is on’ and ‘I’d like to go for walks a little bit more, that is, if I’m well enough’. The home has an ‘open visiting’ policy and residents were observed to receive their visitors both in the privacy of their own rooms and in the communal areas. We spoke to visitors who told us they were made to feel welcome. One person commented, ‘They (staff) are very kind to my mum when she visits my dad. My mum has restricted mobility, but they are always ready to offer a helping hand.’ We observed the midday meal service in the dining room in Cow Lees House. The dining room has been redecorated since the last inspection. It is painted a warm red colour and attractive prints hang on the wall. However, this is a large room with a high ceiling; the floor is an attractive but hard laminate and the windows are dressed with blinds rather than curtains. The size of the room along with the absence of soft furnishings means that noise levels, from clattering of crockery, people talking and the rustling of plastic aprons, are high when the room is used. All residents wore plastic aprons to protect their clothes where large napkins could have been more appropriate for some. Dining tables were covered with lace tablecloths, but were not ‘laid’ with cutlery or condiments for dinner. 17 residents attended the dining room. Several people needed assistance to eat their meals, either by prompting from staff or full physical assistance. We observed five staff members available in the dining room to offer this assistance. Staff sat at the dining tables beside the people they were assisting. The assistance given to residents eating their meals was not consistently sensitive. We observed one staff member sitting at the corner of a table between two residents. The staff member was physically assisting both people to eat their meals, but did not finish helping one person before starting to help the other. Cow Lees Nursing Home DS0000004391.V372764.R01.S.doc Version 5.2 Page 16 She fed the resident on her right with a spoon in her right hand and simultaneously fed the resident on her left from a spoon in her left hand. We observed another staff member sitting with another resident and giving full physical assistance without speaking to the resident to explain what they were doing or to pass the time of day in social chat. These practices do not uphold the personhood of people with dementia care needs. The choice of main meal on the day of our visit was pork and stuffing or beef burger accompanied by mashed potatoes, green beans and cauliflower followed by a dessert of bread and butter pudding or ice cream. Residents were offered the choice of meal just before it was served. The meal looked tasty and nutritious. One resident required a soft diet consisting of each part of the meal, liquidised separately, but served together in a deep bowl. This means the person could not appreciate the taste of each food served. It is recommended that liquidised foods are presented separately to enhance peoples’ appreciation and enjoyment. A staff member observed one resident was not eating her meal. The staff member offered her assistance and a different choice of meal. Eventually, the resident expressed a preference for an alternative snack, which was prepared for her by kitchen staff. One person commented, ‘teatime could be better’. Cow Lees Nursing Home DS0000004391.V372764.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were assessed. Quality in this outcome area is adequate. People living in the home can be confident that their concerns will be listened to and acted upon. Policies for responding to suspicion or allegation of abuse do not reflect multi-agency guidelines for safeguarding people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a formal complaints policy which is accessible to people living in the home and their families. People are encouraged to raise their concerns with the manager or senior staff on duty. We spoke with one relative who told us the manager was approachable and they felt confident that the concerns they raised were addressed. One resident commented, ‘the staff know if I’m not happy and they try hard to cheer me up. They are a happy crowd’. Information shared with us in December 2007 raised concerns about numbers of staff on duty. We referred this to the provider to investigate. A record of complaints and concerns received by the home is maintained along with the action taken by the home regarding each issue raised. The service has recorded one complaint since the last key inspection, which was the complaint we referred to them. The home’s complaint register and action file Cow Lees Nursing Home DS0000004391.V372764.R01.S.doc Version 5.2 Page 18 demonstrates that concerns are listened to and acted upon and timely and objective responses are made. The manager has started recording comments and concerns since the last inspection to demonstrate that the service listens to people using the service. We looked at workbooks completed by staff undertaking abuse awareness training run by Warwickshire council. This demonstrates staff have access to effective abuse awareness training and should mean that they can recognise signs of abuse and are aware of their responsibilities for reporting to senior staff. The home’s policies and procedures for responding to allegations of abuse were reviewed in 2008, but do not reflect current joint agency guidelines to make sure the service works collaboratively with police and social services to respond to suspicion or allegations of abuse. The manager and deputy manager were aware of the need to refer allegations of abuse to social services, but were not aware of Warwickshire Social Services current policy and procedures. We recommend a copy of local guidelines is obtained and reflected in the review of the home’s own policy for responding to allegations of abuse. In May 2008 the manager notified us of an altercation between two residents resulting in a minor injury to one resident. Staff immediately intervened to diffuse the situation and informed the residents’ families and social workers. Care plans were developed to minimise the risk of further altercation. The manager should consider referring incidents involving residents harming each other for investigation under safeguarding procedures to further protect people living in the home. Cow Lees Nursing Home DS0000004391.V372764.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 were assessed. Quality in this outcome area is adequate. The quality of décor and furnishings is variable throughout the home. An ongoing plan of maintenance and refurbishment should ensure residents are provided with an environment, which is safe, homely and comfortable. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 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. The home has an ongoing plan of maintenance and refurbishment. 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. Cow Lees Nursing Home DS0000004391.V372764.R01.S.doc Version 5.2 Page 20 The manager told us they are currently working to reduce the current provision of double rooms to single occupancy accommodation as they become vacant. 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 in Cow Lees House has been redecorated since the last inspection; it has been repainted, flooring has been replaced and paintings hung on the walls. All the armchairs in the lounges in Cow Lees House have been replaced with new ones since the last inspection. The outside courtyard between the two houses has been made secure since the last inspection so that residents can safely access and make use of this area independently. Astley House is a modern purpose built extension, providing spacious accommodation with en-suite bedrooms. There is a conservatory on the ground floor. This house is well decorated, with good quality furnishings. We looked at the bedrooms of people we case tracked. Rooms were comfortable and cosy. All the rooms were personalised with peoples’ own belongings and looked as though it belonged to the person. Privacy screening was available in shared rooms. Equipment is available to assist residents and staff in the delivery of personal care, which includes assisted baths, moving and handling equipment including hoists. Pressure relieving equipment such as cushions and various types of mattress is available for people who have an identified need for them. Systems are in place for the management of dirty laundry. Protective clothing such as plastic gloves and aprons were available and arrangements are in place for the disposal of waste. People told us, ‘I have a nice room and it’s kept nice and clean and tidy’ and ‘my husband’s room is lovely and I’m allowed to put touches to it to make it even better’. Cow Lees Nursing Home DS0000004391.V372764.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 were assessed. Quality in this outcome area is good. There are sufficient competent staff on duty to meet the needs of people living in the home. Residents are safeguarded by robust recruitment procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents are accommodated in two separate buildings. Cow Lees House is the original building and Astley House is a purpose built extension. The home is registered for 52 residents but the manager told us that they are reducing this number by the converting double occupancy rooms into single occupancy accommodation in line with social service’s expectations for residents they assist with funding. 23 residents were living in each house on the day of our visit. Three residents in Cow Lees House and one resident in Astley House require ‘one to one’ supervision for some, or all, of each 24 hour period. The manager told us the usual staffing complement for 46 to 49 residents, described in the following table: Cow Lees Nursing Home DS0000004391.V372764.R01.S.doc Version 5.2 Page 22 Cow Lees House 8am – 2.45pm 1 Registered Nurse and 4 care staff, with a further 3 care staff to support ‘one to one’ care for 3 identified residents 1 registered nurse and 4 care staff, with a further 3 care staff to support ‘one to one’ care for 3 identified residents 1 Registered Nurse and 2 care staff Astley House 1 Registered Nurse and 4 care staff, with a further 1 care staff to support ‘one to one’ care for 1 identified resident 1 registered nurse and 4 care staff, with a further 1 care staff to support ‘one to one’ care for 1 identified resident 1 Registered Nurse and 2 care staff with a further 1 care staff to support ‘one to one’ care for 1 identified resident 2.45pm – 9.30pm 9.30pm – 8am In addition the manager is supernumerary and there are sufficient laundry, catering, cleaning, maintenance and administrative staff to ensure that care staff do not spend undue lengths of time undertaking non-caring tasks. There is a 15 minute overlap for the nursing staff on each shift to enable them to have a ‘handover’ period between shifts. Three weeks of the home’s duty rota between 31st August – 20th September 2008 was examined and demonstrated that the staffing levels set by the home (in the table above) are consistently achieved. It is evident from the outcomes achieved for residents that there are sufficient staff on duty to meet their needs. Staff spoken to confirmed that the staffing arrangements enabled them to meet the needs of residents. Training records show that 25 out of 49 care staff permanently employed in the home have a qualification in care at NVQ (National Vocational Qualification) level two or above which meets the National Minimum Standard for 50 of staff to be qualified. Several more care staff are currently working towards the award. This should mean that residents are cared for by competent staff. The personnel files of two recently recruited staff were examined and both contained evidence that satisfactory pre-employment checks such as Criminal Record Bureau (CRB), Protection of Vulnerable Adult (PoVA) and satisfactory Cow Lees Nursing Home DS0000004391.V372764.R01.S.doc Version 5.2 Page 23 references were obtained before staff started working in the home. Robust recruitment practices safeguard people living in the home from the risk of abuse. A training matrix is maintained and used to record staff training and to identify any gaps in learning. Records demonstrate that staff complete an induction programme and receive mandatory training in moving and handling, infection control, first aid, abuse awareness, fire safety and food hygiene. This should mean that staff are updated in safe working practice. People told us, ‘the staff are always very pleasant and ready to offer any assistance they can’ and ‘the whole staff are very patient’. Cow Lees Nursing Home DS0000004391.V372764.R01.S.doc Version 5.2 Page 24 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): Standards 31, 33, 35 and 38 were assessed. Quality in this outcome area is good. The home is managed by an experienced and competent person to ensure the service is run in the best interests of people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has been in post since 2001. She is a Registered General and Mental Nurse, experienced in the care of older people and has completed the Registered Manager’s Award (NVQ Level 4). There are clear lines of accountability in the home. The deputy manager is allocated some supernumerary time for clinical supervision. Staff spoken with Cow Lees Nursing Home DS0000004391.V372764.R01.S.doc Version 5.2 Page 25 said that the management team were helpful and supportive. The manager told us she has 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 supporting residents’ activities. People commented, ‘I’m very happy at this home. All staff and management are so homely and friendly’, ‘perfect in every way’ and ‘we are more than happy with Cow Lees’. The home’s Quality Assurance file contained evidence that the manager and home owner keep working practices under review and take action when they identify where improvement is necessary. Evidence included stakeholder surveys, resident surveys, meetings with relatives, care plan audits and medicine audits including assessments of staff competency. The manager and provider have taken action to comply with all the requirements and most of the recommendations made during the last inspection resulting in improved outcomes for people using the service, particularly in medicine management and person centred care planning. 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. The Environmental Health Officer’s inspection undertaken in September 2007 found the home had ‘good’ standards in food safety and compliance. The service has prepared an updated fire risk assessment for Cow Lees House and Astley House in response to a requirement made by Warwickshire’s Fire Officer following their inspection in July 2008. Information sent to us in the AQAA told us that equipment is serviced or tested as recommended by the manufacturer or other regulatory body. Cow Lees Nursing Home DS0000004391.V372764.R01.S.doc Version 5.2 Page 26 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 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 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Cow Lees Nursing Home DS0000004391.V372764.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? 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 Regulation 12 Requirement Arrangements must be made to make sure people have sensitive and timely assistance to eat their meals. This is to uphold the personhood of people using the service and make sure their nutritional needs are met in a dignified and sensitive manner. 2. OP18 13 The home’s policies and procedures for responding to suspicion or allegation of abuse must be reviewed and updated to reflect local social services guidelines. Arrangements should be made to make sure the manager and deputy are fully aware of their role and responsibilities in recognising and responding to suspicion or allegation of abuse. This is to safeguard people using the service. 30/11/08 Timescale for action 30/11/08 Cow Lees Nursing Home DS0000004391.V372764.R01.S.doc Version 5.2 Page 28 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 OP7 Good Practice Recommendations Care plans should contain sufficient detail about how to meet people’s needs. This should make sure people get the care they need. Care plans should record the actions taken to minimise any risks that are identified to the health or well being of people using the service so that staff can demonstrate what they are doing to minimise risks. Records of the room temperatures in smaller, ‘satellite’ medicines stores in Astley House should be maintained so staff can be sure that medicines are stored within recommended limits to maintain their stability. 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. The manager should obtain a copy of local social services safeguarding procedures. 2. OP8 3. OP9 4. OP12 6. OP18 Cow Lees Nursing Home DS0000004391.V372764.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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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