Inspection on 10/05/07 for Cowbridge Nursing Home

This inspection was carried out on 10th 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 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

Cowbridge Nursing Home 26/03/09

Cowbridge Nursing Home 09/10/08

Cowbridge Nursing Home 28/03/08

Cowbridge Nursing Home 15/08/07

Cowbridge Nursing Home 14/11/06

Cowbridge Nursing Home 15/05/06

Cowbridge Nursing Home 06/03/06

Cowbridge Nursing Home 16/08/05

Cowbridge Nursing Home 27/01/05

Cowbridge Nursing Home 20/07/04

Similar services:

Fairfields Country Rest Home

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Fairfax House

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

CARE HOMES FOR OLDER PEOPLE Cowbridge Nursing Home Rosehill Lostwithiel Cornwall PL22 0JW Lead Inspector Diana Penrose Key Unannounced Inspection 10th May 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cowbridge Nursing Home DS0000009169.V336549.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. Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cowbridge Nursing Home Address Rosehill Lostwithiel Cornwall PL22 0JW 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) 01208 872227 01208 873109 Cornwallis Care Services Limited Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (30) Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents to include one named adult under 65 years of age with a mental disorder (MD). 14th November 2006 Date of last inspection Brief Description of the Service: Cornwallis Care Services Ltd, own two nursing and one residential care home in Cornwall. Cowbridge Nursing Home is registered to provide accommodation and care to 30 residents who may experience mental health problems or dementia. Cowbridge Nursing Home is a detached property situated on the outskirts of Lostwithiel. The original house has a modern day extension. The grounds are extensive with views over the surrounding countryside. There is an area of garden and a patio that are enclosed and accessible to residents. Accommodation is provided on two floors with a very small passenger lift for access. There are rooms for both single and double accommodation - only one room has en-suite facilities. Assisted bathing and shower facilities are provided. All rooms have call bells. There are three non-smoking sitting rooms with dining incorporated. The dining room is being refurbished. Information about the home is available in the form of a residents’ guide, which can be supplied to enquirers on request. A copy of most recent inspection report is available in the home. Fees range from £550 to £750 per week; this information was supplied to the Commission on the day of inspection. Additional charges are made in respect of private healthcare provision, hairdressing and personal items such as newspapers, confectionary and toiletries. Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors visited Cowbridge Nursing Home on the 10th and 11th May 2007 and fourteen and a half hours at the home. This was an unannounced visit. The purpose of the inspection was to undertake a statutory inspection and to gain an update on the progress of compliance to the requirements identified in the last inspection report dated 14th November 2006. All of the key standards were inspected. On the day of inspection 26 residents were living in the home. The methods used to undertake the inspection were to meet with a number of residents, staff and the management team to gain their views on the services offered by Cowbridge Nursing Home. Records, policies and procedures were examined and the inspectors toured the building. One of the inspectors also undertook a two-hour observation of care practices in one of the lounges of the home. This report summarises the findings of this inspection. There have been management changes at the home since the last inspection. The registered manager has left and there is a second acting manager now in post assisted by an administrator. This is part of the reason for many of the requirements from the last inspection being re-notified. What the service does well: What has improved since the last inspection? Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 6 Some refurbishment and decorating has taken place. The hallway has been decorated and the carpet removed, the floorboards have been varnished. The administrator stated that they have not decided whether to lay carpet again or not. The lounge to the left of the entrance has been tastefully decorated and new furniture has been purchased. One bedroom has been totally refurbished and another is in progress. Some new beds have been purchased along with new bedding. The upstairs assisted bathroom has been completed, although it is not suitable for most of the residents occupying the upstairs bedrooms due to their dependency. Dining facilities are being improved and a quiet lounge is being developed. A new office is being provided for the manager and staff facilities are being improved. New laundry facilities have been provided. A new care planning system is being implemented which should provide more detailed information to staff on how to care for the residents. The pressure sore, medicines and adult protection policies have been updated. The management have further plans for improvements. What they could do better: This key inspection has produced a significant number of statutory requirements, many of which are re-notified. These are legal requirements, which must be implemented by law. An improvement plan is already in place for this home. The resident’s guide must be supplied to each resident and their representative as appropriate to ensure they know what the home has to offer. The assessment document needs to evidence who was involved in the assessment and all sections should be appropriately signed. The new care plans must be fully implemented and reviewed on a monthly basis. More detail is required to ensure staff are fully informed of the care to be provided. Individualised risk assessments are needed for those requiring restraint such as bed rails or wheelchair lap straps. The care plans need to include information regarding the person’s previous life history and interests. Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 7 The care plans must be fully accessible to the care staff and they must be familiar with them. There needs to be a photograph of each resident on care plans and medication records, as many residents have limited cognitive skills and some are now unable to speak clearly. Significant improvement needs to occur regarding the arrangements for residents’ daily life and social activities. At present there is little stimulation to help individuals maintain a sense of their own personhood, or attempts by staff to respect people’s individuality. Residents need to be offered more choices on how to live their daily lives. Staff are kind and caring but need to talk to residents and explain what they are about to do, for example, from observation no attempt was made to inform residents what or when their meal would be or for them to be offered any choice of food available. The manager said the menus and mealtimes are under review, which should improve choices. All staff must receive appropriate adult protection training and management need to be fully aware of the local procedures and the reporting of incidents. The physical environment is poor although it is appreciated that improvements are in progress. The registered provider has started to redecorate some bedrooms, however it does not appear that any advice has been sought regarding the needs of people with dementia. This should certainly be sought regarding the redecoration of other rooms. There are insufficient specialist bathing facilities and this must be reviewed. Although the registered persons do need to ensure residents are physically safe, some of the restrictions on movement of individuals may be over cautious. For example all bathrooms and toilets are locked, so it is not possible for residents to go to the toilet without asking, and people appear to be restricted to a small area (lounge and corridor) during the day. The management did agree to remove locks from communal areas and to keep toilets and bathrooms unlocked. The staff facilities must be completed and utilised. The staff have lockers that are in use but the staff room, toilet and shower are not yet complete. The requirement made at the last inspection is re-notified for the fifth time. There needs to be a review of staffing to ensure there are enough staff to provide activities and to ensure there are always enough staff on duty. Some staff raised concerns during the inspection that at times the home was short staffed. The management must ensure that suitable employment checks are undertaken prior to staff working in the home. These issues have been raised with the registered manager at previous inspections and the requirements are re-notified. Failure to comply could result in the Commission taking enforcement action. Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 8 New staff must be appropriately supervised whilst awaiting the results of employment checks; this was not happening during the inspection. Formal supervision of care staff must also take place, this has not happened for some time. Because of the way the records are laid out, it is difficult to ascertain if individual staff have had suitable training at the correct recommended frequencies. Evidence of other training required by law is not sufficient. Induction records were limited or unavailable. Records must be improved and staff must receive appropriate training to ensure they have the necessary skills to provide a good standard of care to the residents and to ensure the residents are safe in their hands. The management of the home has been poor; there is still a great deal to be done and many regulatory issues to address. The home does not have a registered manager at present and it is hoped that the current management team will run the home effectively and bring about necessary urgent improvements until a registered manager is appointed. An improvement plan is in place with the Commission, although progress in some areas is noted this requires reviewing. The registered provider still does not have a quality assurance system, although inspectors were told this was in hand at the last inspection. There is subsequently no formal method of ascertaining residents and other stakeholder’s views or for developing quality practice and improvement in the home. Despite the legal requirement for the registered provider (or representative) to visit the home unannounced on a monthly basis and send a report to the Commission, reports have not been forwarded to CSCI since August 2006 or provided to the home. There is therefore no evidence the registered provider is meeting their legal responsibility to monitor (and where necessary) bring improvement. An external audit was re-completed in November 2006. This concluded that significant action is still required to meet the standards set by this organisation. Some issues highlighted have also been raised by the Commission for example a suitable risk assessment system and action plan to prevent Legionella, replacement of any substandard glazing, the fitting of thermostatic valves. Emergency lighting needs to be tested at regular intervals as recommended by the fire authority. The registered provider must ensure, accidents and incidents (where appropriate) are appropriately reported in the home and to the Commission. 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. Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 9 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 Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 6 is N/A Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered provider’s statement of purpose and resident guide are satisfactory. This must be provided to residents (and where appropriate their representatives) so that they receive suitable information about the services offered. Residents receive a contract on admission, so they have information regarding their rights and responsibilities. The pre-admission assessment procedure is good, and enables the registered persons to ascertain they can meet the needs of residents, before admission is arranged. EVIDENCE: Evidence was provided in the form of documentation and talking with the mgt team. Copies of the registered provider’s statement of purpose and resident’s guide were inspected and found to be satisfactory. The statement of purpose requires amending to include information regarding the current management Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 11 arrangements and the percentage of staff that have a national vocational qualification. Management said they were not certain if residents and relatives have received a copy of the resident’s guide. However they assured the inspectors that a copy of the guide would be issued to residents (where appropriate) and to residents’ representatives in line with the regulations. A copy of either a social services contract (if the person is state funded) or the registered provider’s contact (if the person is privately funded) was contained in the resident files inspected. The registered provider has a suitable assessment procedure. Records of assessments including that of the most recent resident admitted were inspected. The information gathered was satisfactory however there needs to be evidence of who was involved in the assessment and the documents should all be appropriately signed. Intermediate care is not provided by this service. Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Individual care plans are generated for each resident. However, improvement is required so care plans more fully outline resident’s needs, are regularly reviewed and availability is improved for all care staff. Residents have access to health care services as necessary and specialist equipment is provided. There is a system for dealing with resident’s medicines that is satisfactory and residents are safeguarded. Facilities and staff approaches require some improvement to ensure residents individuality, respect and privacy are maintained and enhanced. EVIDENCE: Evidence was provided in the form of documentation, records, observation, talking with residents, staff and the management team. Management have begun to develop an improved system of care planning. New care plans appear to be an improvement on the previous versions, however the new system is only partly implemented. The new format does not provide any information regarding the person’s previous life history and Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 13 interests. This information is vital to assist staff to get to know individual residents, and to help the resident to maintain their sense of personhood and individuality. In some cases documented interventions need to be more specific; for example it is vital to state how some very vulnerable residents are mobilised or turned. This will ensure consistency of practice, and minimise the risk of accident or injury. There are various risk assessments included with the care plans but there are no individualised risk assessments for those requiring restraint such as bed rails, for example. How to obtain information regarding the use of bedrails was given to the acting manager. It is essential there is a photograph of each resident on care plans and also on medication records, as many residents have limited cognitive skills and some are now unable to speak clearly. The review of care plans is still patchy, and management need to ensure these are reviewed every month. Care plans are currently stored in the manager’s office. Although management said staff were able to use these, several staff the inspectors spoke to said they were not familiar with the care plans. After discussion with management it was agreed care plans would be stored in a new care assistants’ office. Management said the office would be ready by the end of June 2007. One of the inspectors’s completed a two-hour observation of care practices. This focused on observing the interactions of five of the twelve residents sitting in one of the lounges. The inspector concluded from observing staff interactions that staff were well intentioned, although there is some room for improvement if care is to maintain residents respect and privacy. For example staff tend to, perhaps unconsciously, focus on residents who either have a physical personal care need (e.g. feeding, toileting, dealing with ‘difficult’ behaviour) or who are most verbally communicative. Staff did not tend to proactively engage with the residents with the highest need unless personal care was required. One lady, who had been asleep for over an hour, woke up and started to talk. Staff ignored what she said on the two occasions she spoke before the lady went back to sleep again. Even when personal care was provided, staff sometimes did not inform the resident what they were doing. One man was told he needed to have his jumper changed. Staff moved his chair and left him. A member of staff came back five minutes later and he was taken away to have his jumper changed. There was no discussion throughout this process. Staff interventions were variable, and there were other more positive examples of staff-resident interaction. It did not appear that staff were intentionally unkind or practiced poorly, and the reasons for their actions may have been due to the repetitiveness of the routine, or the need to get through certain tasks within a set period. Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 14 Although residents with the highest needs had their personal care needs generally well met, there appeared to be limited engagement to improve these peoples’ sense of wellbeing (e.g. through conversation or other forms of stimulation.) These people subsequently spent most of their time asleep, withdrawn or in a passive state (i.e. as a recipient of care rather than being encouraged to be actively engaged with what is going on around them.) In conclusion there is little stimulation to help individuals maintain a sense of their own personhood, or attempt by staff to respect people’s individuality. There was evidence within the care documentation of visits by healthcare professionals. Suitable equipment is available to staff for moving and handling purposes and pressure relief. A new battery was to be purchased for one of the hoists. Records are maintained for the treatment of pressure sores and other wounds, the acting manager said that the community tissue viability nurse specialist visits regularly. The home’s pressure sore policy has been updated. None of the nurses specialise in a particular subject such as continence or tissue viability, for example, or act as links with external specialists. The medicines policy has been updated and is suitable, however it is very generic and long, it does not state simply what the home does therefore it is not very directive for staff. This was discussed with the management team who will review the policy further when a new registered manager is appointed. A monitored dose system is in use. Medicines are only administered by registered nurses. The medicine administration records were complete however ‘as required’ medicines must state the number of tablets administered, this was discussed at the last inspection. Disposal records now include individual medicines refused, dropped on the floor, and so on. There is an approved list of homely remedies signed by a GP and a suitable policy in place. The storage of medicines and medicinal gases is satisfactory. The acting manager said that care staff receive some medicines training during induction to the home, she agreed to formalise this so that it can be evidenced during inspections. Currently the home heavily restricts individuals’ freedom of movement. Residents based in the main lounge, who are mobile, are restricted to the lounge and the immediate corridor. One lady wishes to constantly walk around but there are limited areas for her to go. Access past the main corridor is not possible as it is locked, and bathrooms and toilets are also locked. There are no areas outside the building that are accessible without assistance. Although it is recognised people with dementia do need some protection from harming themselves, this environment is over restrictive. As a consequence there is little opportunity for residents to find somewhere private, or enjoy different areas within the home. As a consequence respect for people’s privacy is limited. These matters are discussed further in the ‘Daily Life and Social Activities’ and ‘Environment’ sections of the report. Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 15 Screening needs to be provided in one of the shared rooms. The management said they were aware of this issue and a new screen would be provided shortly. Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Only limited activities and stimulation are provided for residents. Routines are institutional and currently do not consider individual wishes and needs. Staff do their best to help residents maintain links with family and friends. Opportunities for individual residents to maintain choice and control over their lives are limited. Although food provided is to a satisfactory standard, improvement is required regarding eating arrangements and support offered at mealtimes. EVIDENCE: Evidence was provided in the form of documentation, records, observation, talking with residents, staff and the management team. As stated in the previous section, one of the inspectors completed a two hour structured observation in one of the two communal lounges. Stimulation was very limited. The television was on throughout the two-hour period, but the volume was on ‘mute’. Nobody was watching the television. Some residents looked through a small collection of old magazines, but these people now generally lacked the cognitive skills to read them. One resident constantly walked around the lounge and the corridor, but as stated movement is Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 17 currently restricted. When not busy with personal care duties (toileting, feeding etc.), staff tended to sit with a more verbally communicative resident. Three of the five observed residents spent the majority of their time asleep. When the inspector spoke to the more able resident who staff had been conversing with, the person said staff were kind, but the person said they were bored and there was seldom anything to do. There were three ‘breaks’ in the inactivity during the observation; morning coffee/ tea / biscuits, toileting and lunchtime. Support provided by staff was generally adequate. Staff generally were well intentioned, and not unkind. However, the inspector felt it must be difficult for them to maintain an air of professionalism each day when the routine was generally tedious and repetitive. This would possibly explain the few occasions where professional relationships were below par. The mealtime, for example, was served in the lounge. No attempt was made to inform residents beforehand what or when the meal would be or for them to be offered any choice of food available. Some residents were provided with aprons although generally there was no explanation what staff were doing when they were putting the aprons on. Some residents were still asleep when their aprons were put on. No offer was made for residents to go to the dining room to have their meal, even though some of the residents had the ability to do so. Food was brought in to the lounge on a trolley, which was placed in the centre of the room. The more able residents ate their meals quickly and seemed to enjoy what was provided. Support provided to those residents who required help was variable. Unfortunately, the mealtime was not really a sense of ‘occasion,’ or ‘highlight’. Staff were very task focused in their approach, it seemed a job, which needed to be completed. Some residents were fed two at a time, and several people were woken up to eat their meal. The gap between them being asleep and being fed was generally no more than 30 seconds. There were some instances where staff attempted to give residents mouthfuls of food before they had finished their last mouthful. For the quicker eaters, no offer of further helpings was provided, although some people would have possibly appreciated this. Tea and coffee was served after the meal. Residents who the inspectors spoke to said they enjoyed the food provided and there was always enough to eat. No actual record of food provided is kept, although one of the manager’s said it did not deviate from the menu. No menu was displayed to help residents understand what was for lunch each day. The inspector observed lunch in the dining room on the second day of the inspection, there were approximately five residents. Support was appropriate, the meal was unrushed and residents appeared to enjoy their meal. Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 18 Concerns regarding meal arrangements were raised at the previous inspection (see report dated 14th November 2006). In the report a requirement was made for the registered provider to review mealtime arrangements, give consideration regarding individual preferences and keep records of food provided. From what was observed no effort has been made to implement this statutory requirement and it is subsequently renotified. On the second day of the inspection, one of the inspectors arrived at the home at 0800. The majority of residents who could get up, were up and dressed. Some were asleep in their chairs. The inspector sat in the lounge, and there seemed no sense of this being early in the morning. Breakfast was served at 0900. There was a choice of cereal or porridge, and toast was also provided. Most residents sat in the ‘main’ lounge, and a few sat in the dining room. Support provided in the dining room by staff at breakfast time was good. Staff talked with residents, and support provided was kind and compassionate. It is a concern however that residents had to wait at least one hour for their breakfast after rising, and that residents have to eat breakfast ‘en masse,’ rather than either in their rooms or in the dining room at a time which personally suited them. The concern raised in the previous report regarding enabling residents to make a choice when they wished to get up has not been implemented and is subsequently renotified. However, on the second day of the inspection, one of the manager’s did say that at least one of the residents had chosen to lie in bed, and denied residents had to get up at a set time. The inspector spent some of the second morning sitting in the second lounge. There were only three people using this room, two of whom were asleep. Staff contact was limited possibly as these residents seemed content to occupy themselves. A member of staff gave one lady a soft toy when she became agitated and this calmed the lady considerably. This seemed really good practice. The television was on in the lounge, although the three people in the lounge displayed no interest in it. There were no other options for stimulation available. A list was displayed of some activities, which would be available, and some (incomplete) records are kept. Management said they planned to introduce further activities such as an entertainer and possibly trips out. Staff would also be encouraged to provide more activities. However evidence from the structured observation would suggest opportunity for staff to provide activities within current staffing levels is perhaps limited. This is due to the work staff have to do to deliver the basic personal care residents require. To improve things the registered provider may require more staff to be available ‘on the floor’, and also further training and guidance to be given. Training and guidance could enable staff to give some residents further opportunity to be involved in basic tasks such as laying tables or helping with Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 19 drying up dishes. The provision of a daily newspaper, local newspapers, magazines etc. could help residents keep some contact with the wider world. The lady who paced the lounge and corridors could be offered a walk in the pleasant grounds. A clock would assist people in knowing what the time is. There are many other simple activities, facilities or equipment that could be provided, which would assist residents to have more stimulation throughout the day. This may involve some amount of calculated risk, but the benefits would help to maintain and increase individuals’ sense of personhood. A requirement was issued in the previous report regarding improving activities. The inspectors could not find any evidence of improvement since the last report and this requirement is renotified. As stated in the previous section, there are too many physical restrictions regarding where residents can go and spend their time. The previous report dated 14th November 2006 outlined a requirement to ensure that restrictions were reviewed and confinement was kept to a minimum. However, there has been little improvement regarding this situation. People in the ‘main’ lounge cannot use the toilets or bathrooms without request, and the corridor door is locked preventing access to the rest of the home without staff escort. This limits where residents can spend their time. Further concerns regarding this matter are reported in the ‘Environment’ section of this report. Visitors are able to see their relatives at any time, and it is evident from the visitors book many residents have friends and family to visit them, sometimes on a regular basis. The inspector was able to speak to one relative who said they were happy with the service provided. Visitors can either meet with their relative in one of the lounges or in the residents’ bedroom. There currently does not appear to be any contact with the local churches or chapels. The administrator stated that a local curate visits one resident and it is hoped that she will be able to do a communal service for residents soon. Suitable arrangements are now in place regarding the management of resident’s monies, none control their own money at present. This subject is covered fully in the management section of this report. It was evident residents are able to bring personal possessions into the home for example people had some small items of furniture, and other small items in their bedrooms. Nutritional needs are assessed but most staff spoken with said they could not access the care documentation. The management said the menus are being changed and a file ‘Menu solutions for care homes’ has been obtained to assist with this. The cook said she had heard that the mealtimes were also being changed although there had been no discussion with her at the time of the inspection. Management confirmed that the mealtimes were going to be changed to space out the meals so that residents did not have such a long gap between tea time and breakfast. Breakfasts would also be more flexible. The Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 20 food appeared good at lunchtime and there was little waste. Homemade cakes are provided every day. There was some evidence of fresh vegetables, the cook said the delivery is weekly. Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure that ensures complaints will be listened to and acted upon. Arrangements are in place for the protection of residents from abuse, however further staff training is required and managers need to be fully aware of the local inter agency procedures. EVIDENCE: Evidence was provided in the form of documentation and talking with the management team. The home has a suitable complaints policy and a method for recording complaints. There have been no complaints received by the home or the Commission since the last inspection. The home’s adult protection policy has been updated and there is a copy of the inter-agency policy in the manager’s office. Some staff have received training regarding the protection of vulnerable adults from abuse, delivered by Cornwall County Council. The remaining staff must receive appropriate training. Management need to be fully aware of the local inter-agency procedures and the reporting of incidents. Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 22 There has been one abuse issue in the home since the last inspection, regarding the restraint of a resident. The investigation is being lead by the department of adult social care. The management must ensure that suitable employment checks are undertaken prior to staff working in the home. These issues have been raised with the registered manager at previous inspections and requirements notified. This area is covered under standard 29 of this report. Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is a suitable size for the people who live there. Although there has been some improvement in the decoration and facilities provided there is still some way to go until the home appears and feels comfortable and homely. There are sufficient toilets in the home however bathroom facilities require significant improvement to assist residents who are frail and / or have mobility problems to bathe. The home is kept clean and the building has no unpleasant odours. EVIDENCE: Evidence was provided in the form of documentation, observation, a tour of the building, talking with staff and the management team. The current management have ensured one of the lounges has been completely redecorated and refurbished to a high standard. There are new Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 24 furnishings, furniture and a new carpet. The room looks pleasant and comfortable. The registered provider has started to redecorate some bedrooms, however it does not appear that any advice has been sought regarding the needs of people with dementia. This should certainly be sought regarding the redecoration of other rooms. There are many publications available which would be useful for the registered provider to look at. Dementia Voice: http:/www.dementia-voice.org.uk/index.htm or the Dementia Development Centre Stirling: http:/www.dementia.stir.ac.uk/publications/design_housing.htm Other organisations may be able to offer assistance or sell publications, which will offer advice regarding suitable design for homes for people with dementia. As stated in the previous section residents are subject to too many restrictions regarding where they can go and spend their time. The previous report dated 14th November 2006 outlined a requirement to ensure that restrictions were reviewed and confinement was kept to a minimum. However, there has been little improvement regarding this situation. People in the ‘main’ lounge cannot use the toilets or bathrooms without request, and the corridor door is locked. This used to be locked via a keypad, which, at the previous inspection, the inspectors said should be removed. Although this has been removed it has been replaced by a key lock. There are now key locks on almost every door for example bathrooms, toilets, the front door, doors on the staircase as well as communal lounge doors. Subsequently the building has greater restrictions than was noted on the previous inspection, and the situation is subsequently totally unsatisfactory. Management during the feedback at the end of the inspection said the locks would be removed from the doors in the communal areas. It is accepted that external doors, and the kitchen / laundry areas need to be locked; although the courtyard garden could be made secure but accessible, if for example suitable restrictions were placed on the perimeter. Discussions took place regarding subsequently enabling residents to move unrestricted between the three lounges and dining room. This would improve the current situation considerably. One of the lounges is still out of use, although the managers said this would be available by the end of June 2007. Part of the room is to be made into an office, with the rest of the room to be a quiet room. The registered provider must however ensure there is no decrease in the amount of communal space as outlined within the statement of purpose. Secondly, consideration needs to be given to the possibility that there could be considerable ‘traffic’ by staff to the office via the ‘quiet’ area of the room. This may result in residents not using the space, and it unintentionally becoming ‘annexed’ for staff use. The previous requirement is subsequently renotified. The upstairs bathroom has now been refurbished. Although there are mechanical chair lifts for the baths, the baths are domestic in type and not Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 25 really suitable for very frail people. On the first floor, residents have to be bathed in bed. A requirement was given in the last inspection report for there to be suitable equipment to wash residents’ hair if they cannot get out of bed. Management said they were still investigating this and subsequently the previous requirement is re-notified. The staff facilities are not yet complete or utilised. The staff have lockers that are in use but the staff room, toilet and shower are not yet complete. The requirement made at the last inspection is re-notified for the fifth time. The home was clean and hygienic on the day of the inspection and there were no unpleasant odours. A sluice facility is provided. There are suitable laundry facilities some of which have been replaced since the last inspection. Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels are generally suitable, although some improvement is required to ensure there are suitable numbers of personnel to provide therapeutic and recreational activities and suitable levels of stimulation. Staff recruitment procedures need improvement so residents can be assured they are satisfactorily protected by pre-employment checks completed on personnel. There are suitable numbers of staff that have a National Vocational Qualification in care, although staff records need to better evidence this. Other staff training, required by law, requires significant improvement so residents can be assured staff are trained and competent to do their jobs. EVIDENCE: Evidence was provided in the form of documentation, records, observation, talking with staff and the management team. Rotas demonstrate there are suitable numbers of staff on duty. For example on the first day of the inspection there were seven staff on duty in the morning, and seven staff on duty from 13:30 to 19:30. This included one registered nurse throughout the period. From 19:30 to 07:30 there were 3 staff including one registered nurse. Auxiliary staff such as cooks, cleaners and maintenance staff are also employed. There however may be some need to look at staff duty allocation to ensure there are sufficient staff available to provide activities as outlined earlier in the report. Some staff did raise concerns to the inspectors Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 27 that at times the home was short staffed. We did not see evidence of this, but the management are reminded they must always ensure there are sufficient numbers of staff, and agency staff need to be used if necessary to ensure that residents needs can be appropriately met. Recruitment records were inspected. These did not show satisfactory checks are carried out. As there have been concerns regarding the registered provider’s compliance with this standard for some time, eighteen staff files were inspected (i.e. for all of the staff on duty during the twenty four hour period on the first day of the inspection). Records of two staff employed in March and April 2007 were also inspected. Although an application form was present for the majority of these staff, only six of the staff had satisfactory references. Both of the new staff only had one satisfactory reference each. One of these staff had one poor reference. Criminal record bureau [CRB], (and Protection of Vulnerable Adults [POVA] ) check procedures are inadequate. Many of the staff had not had a suitable CRB /POVA check since being employed. This included staff who only had a check from their previous employment, and some staff who did not appear to have received any check. Of the two recent employees one person only had a check from their previous employment, and no check had been received for the other employee. Although checks are being completed on the new staff, it was clear they were not being supervised in line with the current guidance issued by the CRB. Both staff did not appear to have received a POVA First check as is now required. The inspector has written a letter of concern to the registered provider, and requested urgent clarification regarding what supervision processes will be put in place. The registered provider has now been notified six times regarding providing suitable staff records, and three times regarding providing suitable CRB /POVA checks. This included an immediate requirement regarding CRB /POVA checks made on 15th May 2006. Previous reports have detailed how this standard has not been met. Failure of the registered provider to ensure suitable employment checks are carried out, within the timescale set could result in enforcement action. Training records were also inspected in regard to the same personnel. Fire training records appear to be adequate. However because of the way the records are laid out, it is difficult to ascertain if individual staff have had suitable training at the correct recommended frequencies. Approximately half of the staff have received infection control training. Seven of the staff had attended Cornwall County Council training regarding the awareness and prevention of abuse. The manager said over 90 of staff have at least an National Vocational Qualification in care at level 2. However only 8 of the 18 staff files inspected contained a certificate to verify this. Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 28 Evidence of other training required by law is not sufficient. Legally all staff who handle food should have food handling training, there should be at least one first aider (at appointed person level) on duty at any one time, all staff should have appropriate moving and handling training, and staff should have training on handling medication if they are involved in this procedure. A previous requirement was made regarding managing challenging behaviour / restraint, and also the needs of people with dementia and /or mental health issues. There is no evidence this has been complied with although one of the managers said training regarding challenging behaviour would be provided shortly. Induction records are either limited or not available for care staff and these must be available for inspection. Some staff did confirm to the inspectors they received an induction when they started work at the home. The two new staff said they kept their records at home. The registered provider has now been notified three times regarding the provision of suitable staff training. Previous reports have detailed how this standard has not been met. Failure of the registered provider to ensure suitable training is provided, within the timescale set could result in enforcement action. Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 29 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Management arrangements need to be improved so residents can be assured the home is managed effectively. There appears little evidence of any systems to ensure the quality of the service is improved. This is essential to ensure residents receive a good quality service and the registered provider can meet regulatory requirements. Satisfactory systems are in place regarding the management of resident monies. Residents can subsequently be assured that were the registered provider is involved in the management of their monies this is carried out to a satisfactory standard. Health and safety requirements are adequate. Some improvement is required so residents can be assured they live in a safe environment. EVIDENCE: Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 30 Evidence was provided in the form of documentation, records, observation, talking with staff and the management team. The registered manager is no longer employed by the Company. The registered provider is currently trying to recruit a new manager who will subsequently need to be registered with the Commission for Social Care Inspection. The deputy manager is currently acting up as the manager of the home until a manager is employed. The registered provider has also employed a ‘consultant’ (administrator) to bring improvements to the home. The person has only been employed a few weeks and is beginning to oversee some changes. It is too early to say whether these will be effective, but there are some signs of encouragement. The Company also employ an operations manager who oversees the three care homes in the group. The acting manager, consultant and operations manager all displayed a positive attitude to the feedback given by the inspectors at the end of the inspection and seemed keen to make the required changes. As a consequence the Commission has decided not to take enforcement action at this stage but give the management an opportunity to bring urgent changes to the home. A quality assurance policy was inspected. This seemed satisfactory, but there is no evidence this has yet been implemented. For example there is no system to ascertain resident (and other stakeholder) views, no annual development plan or other systems, which may assist in bringing about change, and improving quality. An external consultant is employed to complete a health and safety audit, but there did not appear to be any evidence that management knew about the recommendations made in November 2006, or what action would be taken to implement these recommendations. There is also no evidence the registered provider completes monthly visits to the home, as required by regulation 26 of the Care Homes Regulations 2001. The operations manager stated he would be undertaking these in future. Following the last inspection in November 2006, the registered persons were required by the Commission to submit an improvement plan. This was completed. Although progress in some areas is noted many of the requirements in the last report are renotified as further action is required either in part or full. This is detailed fully throughout this report. With regard to personnel checks and training, enforcement notices will have to be served if immediate action is not taken by the registered provider. It is therefore essential for the registered provider to set up a suitable system to bring about service improvement, if this course of action is to be avoided. The policy for the management of resident’s money has been reviewed and updated. The maximum amount to be held for individuals should be included in the policy; the operations manager said he would see that this is included. Resident’s money is held in a non-interest account, the acting manager is a signatory. Individual records are kept on the manager’s computer. These have been printed and held in a file so that written records can be maintained and Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 31 signed by the person dealing with the transaction. The administrator said that a member of the management team will make spot checks and signed on the sheets. The information on the written records will be transferred to the computer records periodically to keep them up to date. Receipts are kept in the safe. The administrator said a copy of the resident’s record is available to the family on request. Receipts are given to relatives when funds are paid to the home. The accounts appear to be used mainly for hairdressing, chiropody and toiletries. The home holds a stock of toiletries that are sold to residents. Resident’s personal choice was questioned and management said that those who are capable could have toiletries of their choice; one woman has Avon for example. They said that relatives often bring toiletries in for residents. There are no valuables held for residents, the administrator said that if needed they would be kept in the safe and receipts issued. The new management team have introduced an appraisal system and documentation has been circulated to staff. There has been no progress with formal supervision therefore the requirement set at the last inspection is renotified for the third time. The home has a suitable health and safety policy. An external audit was recompleted in November 2006. This concluded that significant action is still required to meet the standards set by this organisation. Some issues highlighted have also been raised by the Commission for Social Care Inspection. For example a suitable risk assessment system and action plan to prevent legionella, replacement of any substandard glazing, the fitting of thermostatic valves. The operations manager said during the feedback, improved glazing had been fitted for example in the refurbished lounge. If this is the case there should be a watermark on the glass to state it is toughened. The provider needs to check this. He also said thermostatic values on baths and showers would be fitted shortly. The outbuildings have been risk assessed and staff are no longer allowed to access this area. A copy of the risk assessment was displayed on the notice board. The fire book was inspected. Tests on call points for the fire alarm, fire extinguishers and fire doors appear to be tested regularly. However emergency lighting needs to be tested at regular intervals as recommended by the fire authority. The fire alarm system and fire extinguishers appear to have been serviced in the last year. Portable electrical appliances were tested between January and March 2007. Management said the electrical hardwire circuit had been tested, but a certificate was not available for inspection. This must be tested at least every five years. The certificate must be forwarded to the Commission. A gas safety certificate was available for inspection- although there was no recent record of the boiler being serviced. Management said this had been completed, if so, evidence needs to be forwarded to the Commission. Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 32 The lift and other moving and handling equipment appears to have been serviced within the last six months, according to records inspected. Testing has been completed by Restormel council regarding the private water supply. Accident reports are maintained but not all accidents are reported in the appropriate manner; some are recorded in the daily records without an accident report form completed. All accidents in the home should be recorded on an accident report form, this must include all falls even when they are not witnessed. The registered provider must ensure, accidents and incidents (where appropriate) are reported to the Commission under Regulation 37 of the Care Homes Regulations 2001. As the requirement regarding health and safety has not been fully complied with it is subsequently renotified. The registered provider has now been notified three times regarding suitable providing suitable health and safety checks and precautions. Previous reports have detailed how this standard has not been met. Failure of the registered provider to ensure suitable health and safety checks and precautions within the timescale set could result in enforcement action. Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 33 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 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 1 1 1 X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 X X 1 Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5(2) Requirement Timescale for action 01/08/07 2. OP7 15 A copy of the resident’s guide must be supplied to each resident (and to that person’s next of kin if this is appropriate). 01/08/07 The registered person shall: • After consultation with the resident, or a representative of her/ his, prepare a resident plan for each resident outlining the resident’s needs in respect of their health and welfare. • Make the resident’s plan available to the resident • Keep the resident’s plan under review • Where appropriate and, unless it is impracticable to carry out such consultation, after consultation with the resident or a representative of his, revise the resident’s plan; and notify the resident of any such revision. (Previous timescale of 01/03/07 not met 2nd Notification) DS0000009169.V336549.R01.S.doc Version 5.2 Cowbridge Nursing Home Page 35 3 OP12 16 (2) (m) The registered persons shall consult with residents about their social interests, and make arrangements to enable them to engage in local, social and community activities. (Previous timescale of 01/02/07 not met 2nd Notification) 01/08/07 4 OP14 12(2)(3)1 6(2)(i) The registered persons must, so far as practicable, enable residents to make decisions with respect to the care they are to receive and their health and welfare. They shall so far as practicable take into account their wishes and feelings. For example: • The registered persons need to monitor and ensure residents can get up and go to bed according to their wishes • Arrangements for mealtimes, support provided to residents and food provided must be reviewed. Residents’ preferences regarding food must be considered, for example there should be a choice of meal. Suitable records to evidence this must be kept. • Freedom of movement around the building must be assessed and confinement of residents kept to a minimum. • Residents must be individually risk assessed regarding their ability to use bathroom / toilet facilities, and where necessary suitable DS0000009169.V336549.R01.S.doc 01/08/07 Cowbridge Nursing Home Version 5.2 Page 36 support measures put in place. The registered persons should seek specialist advice from external professionals regarding alternative strategies to locking bathrooms / toilet doors to prevent access. (Previous timescale of 31/12/06 not met 2nd Notification) 5 OP18 13 (6) The registered person shall make arrangements, by training staff or by other measures, to prevent residents being harmed or suffering abuse or being placed at risk of harm or abuse. • All staff must receive appropriate abuse training 01/08/07 ( Previous timescale of 31/12/06 not met 3rd notification) 6 OP19 OP20 OP21 OP22 16, 23 The registered provider must ensure the care home is suitable for achieving the aims and objectives set out in the statement of purpose. For example; the registered person shall having regard to the number and needs of the residents ensure that— • Suitable adaptations are made, and such support, equipment and facilities, as may be required are provided, for residents who are old, infirm or physically disabled; (for example specialist bathing facilities such as a ‘parker’ type bath.) Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 37 01/08/07 (Previous timescale of 31/12/06 not met 2nd Notification) • The premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally; • All parts of the care home are kept reasonably decorated; • The physical design and layout of the premises to be used as the care home meet the needs of the residents; (Previous timescale of 31/12/06 not met 2nd Notification) • There is adequate sitting, recreational and dining space. 7 OP21 13, 16, 23 The registered persons shall provide suitable facilities and services to residents. (For example there must be suitable equipment to wash residents’ hair if they cannot get out of bed.) (Previous timescale of 01/02/07 not met 2nd Notification) 8 OP29 17 (2) The registered persons shall maintain in the care home the records specified in Schedule 4. (All of the recruitment records required by legislation must be obtained and maintained). (Previous timescale of 31/12/06 not met 6th Notification) 9 OP29 13, 19 The registered persons must DS0000009169.V336549.R01.S.doc 01/08/07 01/08/07 01/08/07 Version 5.2 Page 38 Cowbridge Nursing Home ensure all staff have a Criminal Records Bureau check / Protection of Vulnerable Adults check. (Previous timescale of 31/12/06 not met 3rd Notification) Suitable supervision arrangements for staff that do not have appropriate checks returned must be in place. 10 OP30 18 (1) (c) The registered persons must ensure that the persons employed to work at the care home receive, training appropriate to the work they are to perform including structured induction training. This includes training: • In the management of challenging behaviour and restraint techniques. • Required by regulation such as fire training, first aid, food hygiene, infection control and moving and handling. • regarding medication • regarding abuse and protection • regarding people with mental health needs and dementia • regarding induction to the home (Previous timescale of 01/02/07 not met 3rd Notification) 01/12/07 11 OP38 23 The registered person shall 01/08/07 provide for staff suitable facilities for the purpose of changing and storage. (Previous timescale of 01/02/07 not met 5th Notification) The registered person shall DS0000009169.V336549.R01.S.doc 12 OP7 13(4)(b) 01/08/07 Version 5.2 Page 39 Cowbridge Nursing Home (c) ensure that all parts of the home to which residents have access are so far as reasonably practicable free from hazards to their safety, any activities in which residents participate are so far as reasonably practicable free from avoidable risks and unnecessary risks to the health or safety of residents are identified and so far as possible eliminated. • Relevant risk assessments must be undertaken for each resident and there must be a specific risk assessment undertaken for the use of any form of restraint. • There must be an indication as to how risk assessments are scored and the actions to be taken must be recorded in the care plans to direct staff • The registered persons must liaise with the Health and Safety Executive to ascertain that precautions to control the temperature of hot water (at outlet) are satisfactory. Any recommendations must be implemented. (Previous timescale of 01/03/07 not met 4th Notification) 13 OP31 26 Where the registered provider is an individual, but not in day-today charge of the care home, she or he shall visit the care home in accordance with this regulation, and supply a copy of the report to the Commission. (Previous timescale of 01/12/06 not met 2nd Notification) The registered persons shall DS0000009169.V336549.R01.S.doc 01/06/07 14 OP33 24 (1) 01/08/07 Version 5.2 Page 40 Cowbridge Nursing Home establish and maintain a system for evaluating the quality of the services provided at the care home. (Previous timescale of 01/12/06 not met 2nd Notification) The registered persons shall ensure that persons working at the care home are appropriately supervised • All care staff must be provided with regular supervision including one to one supervision, at least six times a year, with records kept (Previous timescale of 01/03/07 not met 3rd Notification) 16 OP38 13(4) 23(4) (5) The registered person shall ensure that all parts of the home to which residents have access are so far as reasonably practicable free from hazards to their safety, any activities in which residents participate are so far as reasonably practicable free from avoidable risks and unnecessary risks to the health or safety of residents are identified and so far as possible eliminated. The registered persons shall take adequate precautions against the risk of fire and undertake appropriate consultation with the authority responsible for environmental health. • Emergency fire lighting must be tested at intervals recommended by the fire officer. An electrical hardwire test Version 5.2 Page 41 15 OP36 18 (2) (a) 01/12/07 01/08/07 • Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc • • must be completed at least every five years. Once completed a copy of the documentation must be forwarded to the commission. There must be a suitable system of health and safety risk assessment including the prevention of Legionella. Risk assessments must be dated and reviewed at least annually. Once completed a copy of the documentation must be forwarded to the commission. The boiler must be tested at least annually. A copy of the documentation must be forwarded to the commission. 17 OP38 17 18 OP38 37 (Previous timescale of 01/02/07 not met 3rd Notification) The registered person shall maintain in the care home the records specified in Schedule 4. The registered person shall give notice to the Commission without delay of the occurrence as outlined within this regulation. (for example any serious injury to a resident, any event in the care home which adversely affects the wellbeing or safety of any resident, any allegation of misconduct by the registered person or any person who works at the care home). 01/06/07 01/06/07 Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 42 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP7 OP7 OP24 Good Practice Recommendations Individual life histories should be compiled for each resident. All of the care documentation for an individual resident should be held in one file. A sluice with a washer disinfector should be provided upstairs. Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 43 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cowbridge Nursing Home DS0000009169.V336549.R01.S.doc Version 5.2 Page 44 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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