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Inspection on 15/05/06 for Cowbridge Nursing Home

Also see our care home review for Cowbridge Nursing Home for more information

This inspection was carried out on 15th May 2006.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents are assessed prior to admission to the home and a written care plan is compiled. A suitable number of nurses and care staff are on duty at all times. Residents and relatives spoken with said the staff are kind and caring and they are happy with the standard of care provided. Staff were observed to treat the residents in a caring manner and with respect. Visitors are welcome to the home and records show that the home has a lot of visitors. One of the nurses is responsible for arranging suitable activities for the residents. There are records kept and photographs of residents enjoying themselves. Residents were enjoying activities during the inspection. A varied menu is on offer with fresh fruit and vegetables. Homemade cakes are available each day. Residents told the inspectors that the food provided is to a good standard. The cook is undertaking advanced food safety training to help ensure that high standards are maintained in the kitchen. Care staff are encouraged to undertake NVQ training and the registered manager said that all care staff employed, bar one, have either achieved a qualification or are studying towards one. The registered manager and staff at Cowbridge welcome the inspectors to the home. They are keen to discuss ways in how to improve standards in the care that Cowbridge provides to its residents.

What has improved since the last inspection?

The outbuildings have been cleared of rubbish and the lower part is no longer used for the storage of incontinence pads, toilet rolls or other such items. Suitable floor covering has been fitted in the en suite facility in room 23. Some improvements have been made to the care plans and they are now being stored in separate plastic folders. The staff facilities are in the process of being up graded.

What the care home could do better:

As the last inspection was only two months ago most of the requirements and recommendations have not yet been addressed. The total requirements notified in this report are 30 with 11 recommendations. The statement of purpose and several policies require updating to fully direct staff in what is expected at Cowbridge and how they achieve this. Record keeping in the home must improve to ensure that relevant records are maintained and legislation complied with. Further work is required to ensure the care plans fully inform and direct staff in the individual care to be provided. Risk assessments must be relevant and more detailed with a record of the action staff are expected to take. Care plans should be compiled with the resident or their representative whenever possible to ensure that the care provision is appropriate Some practices around medicines must improve to fully ensure the safety of residents. The home is very run down and requires extensive attention. An action plan for the redecoration and refurbishment of the home is required to include the replacement of carpets and furniture. The Commission is still awaiting an action plan from the registered manager on how the health and safety issues identified in their audit of the premises are to be addressed. Although the outbuildings have been cleared they still need to be made safe, possible with a secure door across the entrance. A review of the bathing facilities is required to ensure that all residents can be provided with the amenities to meet their needs. Although the home is clean and tidy the registered manager must ensure an alternative cleaning material is used to eliminate the strong unpleasant smell of disinfectant that is noticeable on entering the home. Improvements are required to the temperature and ventilation of the home, it was very hot on the day of the inspection and the ventilation, particularly in the office was inadequate.The health and safety precautions have lapsed and the registered manager must ensure that tests in respect of fire equipment and servicing of equipment, for example are undertaken regularly. Recruitment practices have improved in some respects however immediate requirements were notified at this inspection for the registered manager to ensure that staff do not start work without references being obtained and necessary checks being undertaken. Staff receive some training but the training legally required has not been kept up to date, for example, fire, moving and handling and induction of new staff. Certificates were not held to evidence the training undertaken. The system for the handling of resident`s money does not prevent residents from the risk of financial abuse and must be tightened up.

CARE HOMES FOR OLDER PEOPLE Cowbridge Nursing Home Rosehill Lostwithiel Cornwall PL22 0JW Lead Inspector Diana Penrose Unannounced Inspection 15th May 2006 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.V293718.R01.S.doc Version 5.1 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.V293718.R01.S.doc Version 5.1 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 Mr Vaithilingam Herren 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.V293718.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents to include one named adult under 65 years of age with a mental disorder (MD). 6th March 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. Cornwallis 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 that has been made accessible to residents. Accommodation is provided on two floors with a 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 although limited. All rooms have call bells. There are three non-smoking sitting rooms and a separate dining room. The small sitting room is temporarily being used as a staff area whilst the staff room is being upgraded. Cowbridge Nursing Home DS0000009169.V293718.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors visited Cowbridge Nursing Home on the 15 May 2006 and spent seven 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 16/03/06. All of the key standards were inspected. On the day of inspection 30 residents were living in the home. The methods used to undertake the inspection were to meet with a number of residents, staff and the registered manager to gain their views on the services offered by Cowbridge Nursing Home. Records, policies and procedures were examined and the inspectors toured the building. This report summarises the findings of this inspection. What the service does well: Residents are assessed prior to admission to the home and a written care plan is compiled. A suitable number of nurses and care staff are on duty at all times. Residents and relatives spoken with said the staff are kind and caring and they are happy with the standard of care provided. Staff were observed to treat the residents in a caring manner and with respect. Visitors are welcome to the home and records show that the home has a lot of visitors. One of the nurses is responsible for arranging suitable activities for the residents. There are records kept and photographs of residents enjoying themselves. Residents were enjoying activities during the inspection. A varied menu is on offer with fresh fruit and vegetables. Homemade cakes are available each day. Residents told the inspectors that the food provided is to a good standard. The cook is undertaking advanced food safety training to help ensure that high standards are maintained in the kitchen. Care staff are encouraged to undertake NVQ training and the registered manager said that all care staff employed, bar one, have either achieved a qualification or are studying towards one. The registered manager and staff at Cowbridge welcome the inspectors to the home. They are keen to discuss ways in how to improve standards in the care that Cowbridge provides to its residents. Cowbridge Nursing Home DS0000009169.V293718.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: As the last inspection was only two months ago most of the requirements and recommendations have not yet been addressed. The total requirements notified in this report are 30 with 11 recommendations. The statement of purpose and several policies require updating to fully direct staff in what is expected at Cowbridge and how they achieve this. Record keeping in the home must improve to ensure that relevant records are maintained and legislation complied with. Further work is required to ensure the care plans fully inform and direct staff in the individual care to be provided. Risk assessments must be relevant and more detailed with a record of the action staff are expected to take. Care plans should be compiled with the resident or their representative whenever possible to ensure that the care provision is appropriate Some practices around medicines must improve to fully ensure the safety of residents. The home is very run down and requires extensive attention. An action plan for the redecoration and refurbishment of the home is required to include the replacement of carpets and furniture. The Commission is still awaiting an action plan from the registered manager on how the health and safety issues identified in their audit of the premises are to be addressed. Although the outbuildings have been cleared they still need to be made safe, possible with a secure door across the entrance. A review of the bathing facilities is required to ensure that all residents can be provided with the amenities to meet their needs. Although the home is clean and tidy the registered manager must ensure an alternative cleaning material is used to eliminate the strong unpleasant smell of disinfectant that is noticeable on entering the home. Improvements are required to the temperature and ventilation of the home, it was very hot on the day of the inspection and the ventilation, particularly in the office was inadequate. Cowbridge Nursing Home DS0000009169.V293718.R01.S.doc Version 5.1 Page 7 The health and safety precautions have lapsed and the registered manager must ensure that tests in respect of fire equipment and servicing of equipment, for example are undertaken regularly. Recruitment practices have improved in some respects however immediate requirements were notified at this inspection for the registered manager to ensure that staff do not start work without references being obtained and necessary checks being undertaken. Staff receive some training but the training legally required has not been kept up to date, for example, fire, moving and handling and induction of new staff. Certificates were not held to evidence the training undertaken. The system for the handling of resident’s money does not prevent residents from the risk of financial abuse and must be tightened up. 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. Cowbridge Nursing Home DS0000009169.V293718.R01.S.doc Version 5.1 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 Cowbridge Nursing Home DS0000009169.V293718.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Prospective residents are given information about the home but it does not enable them to make a fully informed choice of home. Most residents have a written contract and terms and conditions of residency but this is not consistent and many were not signed. Residents are only admitted to the home following an assessment of their needs the format of this assessment is appropriate but tends not to be completed in sufficient detail. EVIDENCE: The home has a statement of purpose and residents guide. The statement of purpose requires reviewing and updating to include all of the information listed in Schedule 1. The areas lacking were discussed with the registered manager. Not all residents had a Cowbridge contract. Some had a Social Services contract, one resident had no contract, and the registered manager stated that this resident’s contract had been sent to the company’s head office in St Ives. Not all of the home’s contracts inspected had been signed by the residents or their representative. Cowbridge Nursing Home DS0000009169.V293718.R01.S.doc Version 5.1 Page 10 The registered manager said that prospective residents are visited, often in hospital, prior to deciding to admit them to the home. The form used to record the assessment is comprehensive and covers all of the areas listed in standard 3.3. Not all of the assessments inspected were signed by the person carrying out the assessment. Not all sections of the assessment sheet were completed or a reason recorded for the omission. One resident admitted in March 2006 had an assessment carried out in November 2005; there was no evidence of a further assessment prior to admission although the registered manager said this did take place. Social Services assessments were on file where appropriate. It is recommended that the assessment document states who is involved in the assessment process and from where the information is obtained. Cowbridge Nursing Home DS0000009169.V293718.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individual care plans are generated for each resident but are not all available and do not always fully inform and direct staff in the care to be provided. Residents have access to health care services as necessary, policies need to be updated to ensure staff deliver care appropriately and ensure the assessed needs are met. There is a system for dealing with resident’s medicines; the policy is not up to date and extra vigilance is required to ensure residents safety. Systems are in place to ensure that residents are respected and their privacy is upheld. EVIDENCE: Care plans are held in individual folders but the rest of the care documentation and risk assessments are held in separate files. It is recommended that all of the care documentation for an individual resident be held in one file. Of the residents case tracked, not all had a care plan that was available to the care staff. One was held on the registered manager’s computer, another had no care plan but had been living in the home for two months. Staff confirmed they were aware residents had a care plan, and said these are available to them. Cowbridge Nursing Home DS0000009169.V293718.R01.S.doc Version 5.1 Page 12 The care plans must refer to the risk assessments and other records to fully inform and direct the care staff. They still need to evidence whether the resident or their representative is involved in the compilation. The plans are generic and not always updated to reflect the individual’s needs. Life histories should be compiled for all residents, to inform staff and enable them to provide appropriate care. There must be a specific risk assessment undertaken for those at risk of falling. Relevant risk assessments must be undertaken for each resident with an indication as to how a score is attained, for example for moving and handling and Waterlow. The actions required following the risk assessment must be recorded to direct staff. If a resident is thought to require restraint there must be a written risk assessment. Following discussion with the resident’s representative and relevant healthcare professionals there should be written consent gained for any form of restraint used, for example, cot-sides or wheelchair lap straps. The majority of residents the inspector spoke to were satisfied with the care they received. One resident said staff could at times be a bit rough and rushed. The inspector however observed care practices generally as satisfactory. Inappropriate moving and handling techniques are used in the home; the registered manager said he is addressing this. A relative said her grandmothers healthcare needs are met. A GP visited during the inspection and there was evidence within the care documentation of visits by other healthcare professionals. Suitable equipment is available to staff for moving and handling purposes and pressure relief. Records are maintained for the treatment of pressure sores and other wounds. The home’s pressure sore policy still requires updating. Several areas need to be more specific for example it refers to an approved scale being used but does not state the one used in the home, it does not state how a pressure relieving mattress is obtained, who decides on the type of dressing, any links with the specialist tissue viability nurse, turning ought be according to individual assessment rather than 2-3 hourly as stated in the policy. The medicines policy also requires further reviewing and updating and must state what the home actually does. The appendices referred to were not attached to the policy. A monitored dose system is in use. Medicines are only administered by registered nurses, there has been no medicine training but the registered manager said the nurses are due to undertake update training in September 2006.The medicine administration records were complete but hand written details on the MAR charts were not signed by two members of staff. Thick and easy powder prescribed for an individual resident must not be administered to anyone else. All medicines for disposal, including those refused or dropped on the floor for example, must be recorded and disposed of in the Cowbridge Nursing Home DS0000009169.V293718.R01.S.doc Version 5.1 Page 13 correct manner, not thrown down the sink. Some residents had a photograph inserted with their MAR chart, this should be extended to all residents. The temperature of the medicines fridge should be monitored and recorded at least weekly. Storage of medicines and medicinal gases is satisfactory. Residents’ privacy was upheld during the inspection. Shared rooms are provided with appropriate screens. Privacy and dignity is included to a degree in the home’s statement of purpose, the registered manager said he would include the home’s privacy and dignity policy. Cowbridge Nursing Home DS0000009169.V293718.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a range of activities and aims to meet individual residents needs. Links with family and friends are good and allow residents the opportunity to socialise. Residents are helped to maintain control over their lives and it staff respect their individual preferences and choice. Dietary needs of residents are catered for with a varied menu that aims to be to their liking. EVIDENCE: Activities take place in the home and residents can choose whether to join in. One nurse is responsible for organising activities and a session was taking place during the inspection. The organiser said one to one sessions take place with individual residents, for example a chat, manicures or reading a book. Records are maintained for individuals in a file and there are photographs of residents enjoying activities. Activities include crafts, flower arranging, music, ball games, jigsaws, painting, story reading and board games. Staff said that residents could receive visitors at any time; the visitor’s book showed that several people visit the home each day. One relative said she could visit when she likes and can contact the home by telephone. Cowbridge Nursing Home DS0000009169.V293718.R01.S.doc Version 5.1 Page 15 Some residents said they got up at 6 am, and they had to do so because staff had a lot to do. However two residents said they could get up when they wished. The registered manager said no resident had to get up before 6am, and where possible they were given a choice when they wanted to get up. All residents said they could go to bed when they wished- usually about 9pm. There is a set 4-week menu; the cook said the nursing staff advise her on the daily requirements for residents. The cook said there are alternatives to the set menu for those wishing to have something different or for those on special diets. Fresh fruit and some fresh vegetables were seen in the home. The cook said she has sufficient ingredients to provide good food. The food records could not be found, however the cook had recorded those having an alternative to the menu on a calendar in the kitchen. She said the records would be more detailed when they are entered into a new diary soon to be implemented. The inspector was present at the mealtime. The majority of residents had their meal in their armchair in one of the three sitting rooms. Some, who were able, got up to the table to have their meal. Some remained asleep while others were eating. The inspector asked the manager why the dining room was not used for mealtimes. The manager said it had been agreed it would be difficult for many of the residents to leave their chairs and get up to the table, considering pain suffered and mobility difficulties. Staff support seemed to be satisfactory; when staff were assisting residents with feeding there was some evidence of interaction. The meal was sausages and gravy, with potatoes and frozen peas. A sweet was served afterwards. All residents the inspector spoke to said food was to a good standard. Homemade cakes are available for residents. Cowbridge Nursing Home DS0000009169.V293718.R01.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 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 are listened to and acted upon. Arrangements are in place for the protection of residents; further action is required to safeguard them from harm or abuse EVIDENCE: The home has a complaints policy and a method for recording complaints. No complaints have been received. Thank you cards and letters are kept. The complaints policy requires updating and it should state that complaints can be made directly to the CSCI at any time, not only if a complainant is dissatisfied with the home’s investigation. There is an adult protection policy in place but the reporting process is inappropriate. The process to be followed in the event of an incident or allegation of abuse must refer to contacting Cornwall Adult Social Care prior to involving the police or the home undertaking any investigation, as recently happened. POVA training has been taking place, the registered manager said he has attended this; he must refer to the information received during this training when updating the policy and seek advice from adult social care if necessary. Cowbridge Nursing Home DS0000009169.V293718.R01.S.doc Version 5.1 Page 17 Cowbridge Nursing Home DS0000009169.V293718.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 25 & 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 in need of maintenance, decoration and refurbishment and the outbuildings must be addressed to ensure a safer more comfortable environment for residents, staff and visitors. There are sufficient toilets in the home; the bathing facilities are not all suitable so some are not used and residents have to be bathed a long way from their room. Heating in the home is very hot and ventilation is poor in some areas this does not allow for a comfortable safe environment for residents or staff. The home is kept clean but the strong smell of disinfectant is very unpleasant. EVIDENCE: The inspectors toured the building and the home was observed to be clean but getting very run down. Carpets are beginning to look worn and in some cases dirty. Paintwork in many areas is damaged, and most areas look in need of redecoration. On entry visitors can immediately smell disinfectant, which after a while becomes very unpleasant. The registered manager must find an Cowbridge Nursing Home DS0000009169.V293718.R01.S.doc Version 5.1 Page 19 alternative cleaning material so the building smells better. The maintenance manager has undertaken substantial work at the home but there is still a great deal of general maintenance work to do. The home is a secure unit and residents have access to a secure garden area. The grounds are generally very pleasant and there is a fence that provides some safety from the steep garden at the front of the property. The decoration of the outside of the home is satisfactory, however there are a range of outbuildings, that are not secure and contain tools and so on. The possibility of fitting a door across the entrance to the outbuildings was discussed with the maintenance manager to make it safer. Various areas at the side and rear of the building are untidy, and these issues also need attending to. It is noted that the greenhouse has been removed and it is intended to erect a shed in this area for storage purposes. Bedrooms offer basic accommodation. There is some attempt at individualisation, but on the whole bedrooms appear uniform. There is little variation in colour schemes or the standard of floor coverings. Many articles of furniture in bedrooms are damaged or badly worn. Bedrooms do not have locks on the doors. However on the ground floor bedroom doors have a bolt at the top. The manager said all the doors were locked with a bolt to prevent a minority of residents entering other residents’ bedrooms. This method is inappropriate as it could result in residents getting locked in their bedrooms and not being able to get out. It could prevent residents entering their own bedrooms. The locks therefore must be removed and an alternative method of locking the rooms / preventing unwanted visitors must be found. Carpets in bedrooms 23 and 9 need replacing. Wallpaper in bedrooms 22 and 29 was peeling off. There is quite a serious crack in the wall in bedroom 29, which needs attending to. Bathroom facilities are not adequate. Many of the bathing facilities are domestic in type and not suitable for residents who are in pain and / or have mobility problems. There are no specially adapted facilities on the first floor resulting in residents having to go downstairs to have a bath. Some of the residents on the first floor now have to spend significant periods of time in bed, so bathing facilities are particularly inappropriate, especially as the lift is on the small side. Facilities therefore must be improved for example the provision of assisted bathing facilities for residents such as a ‘Parker’ type bath. Ventilation in the home is poor. The office was stifling on the day of inspection, and far too hot to work in. An external audit completed by the registered provider in June 2005 came to the same conclusion, but no action appears to have been taken. There are concerns regarding health and safety checks carried out which are outlined in the final section of the report. Cowbridge Nursing Home DS0000009169.V293718.R01.S.doc Version 5.1 Page 20 The staff room is being improved and work is still in progress, meanwhile the staff are utilising the small sitting room as their staff area. The kitchen is large and fitted with stainless steel units. The laundry facilities are satisfactory and suitable hand-washing facilities are provided with alcohol hand cleansing gel available. Cowbridge Nursing Home DS0000009169.V293718.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels appear to be satisfactory so residents can be assured they will receive appropriate levels of support from staff. Residents are in safe hands and benefit from the 81 of care staff trained to at least NVQ level 2 in care. Recruitment procedures are not robust enough to offer maximum protection to the residents. The training provided for staff is insufficient for them to be fully skilled and competent in their roles. EVIDENCE: The rota was inspected, and the inspector was provided with the names of staff on duty on the day of the inspection. There seemed suitable numbers of staff on duty, and resident’s needs appeared to be met promptly. On the day of the inspection the following staff were on duty: • From 0730 until 13:30 2 nursing staff. • From 0730 until 1330 6 care staff. • From 13:30 until 1600 2 nursing staff, one of whom is working until 19:30. • From 13:30 until 18:30(1) or 19:30 (5) care staff • From 19:30 until 07:30 1 nursing staff and 2 care staff. Auxiliary staff such as cooks, cleaners and maintenance staff are also provided. Cowbridge Nursing Home DS0000009169.V293718.R01.S.doc Version 5.1 Page 22 Staff support was observed to be professional and competent. The majority of residents said staff were supportive, friendly and caring. Staff records were inspected, and information obtained for recruitment purposes was generally satisfactory. However, one member of staff had not had a Criminal Bureau check / Protection of Vulnerable Adults check, as required by regulation. No references had been received for this person either. The registered provider appears to have a satisfactory approach to ensuring staff have a National Vocational Qualification in care. On the day of the inspection 9 of the 11 care staff (excluding nursing staff) had an NVQ either at level 2 or 3 and three others are studying towards a qualification. Copies of NVQ certificates must be kept on file so the Commission can be provided with suitable evidence this standard is met. Two overseas nurses are undertaking their adaptation course at the home under the Plymouth University. The registered provider’s approach to ensure staff receive the training, required by regulation, needs improvement. By law all staff must have moving and handling, fire and infection control training. The law also states there must always be one approved first aider on duty. All food handlers such as the cooks, and care staff handling food, must have a food-handling certificate. New staff must also receive a comprehensive induction. The registered manager keeps a chart of the training staff have received. Records inspected show gaps in training and most certificates were not available for inspection. Similarly, no certificates were available for inspection regarding medication training. This training must be provided to all staff that handle medication, and there must be evidence of attendance. Only a minority of staff have received any training regarding mental health needs and dementia, and this must be provided so staff can adequately meet the needs of the residents. There appeared to be no documentary evidence in staff files that new staff had received an induction. The cook said she has achieved the Intermediate Food Hygiene Certificate and has almost completed the advanced food hygiene certificate. She is soon to commence the advanced food safety certificate. A member of staff said training had improved and some recent courses in record keeping were noted on the duty rota. Cowbridge Nursing Home DS0000009169.V293718.R01.S.doc Version 5.1 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The Registered Manager is a registered mental nurse and fit to run the home. There appears to be no formal consultation between the registered provider, residents and their representatives so they have little input to improving the service. There is a system in the home for dealing with residents’ money; further safeguards must be put in place to protect the residents’ financial interests. Health and safety measures are completely unsatisfactory; there is little assurance that residents live in a safe environment. EVIDENCE: The registered manager has been in post for approximately 18 months and has made several improvements to systems during this time. However there is still a great deal to achieve at the home. He appears to work duties in the home frequently and was working night duties during the week of inspection. This may not allow him to manage the home effectively. He said he keeps up to Cowbridge Nursing Home DS0000009169.V293718.R01.S.doc Version 5.1 Page 24 date with current issues by studying and reading the nursing press. He said he is undertaking a PhD in Alzheimer’s disease. Staff said the manager gets on with things and listens to the staff even when they disagree with him. There were no adverse comments made. There is no evidence of any quality assurance process in place. The registered manager said he had received a quality assurance package, but had not had time to implement this. The home has a policy for the management of resident’s money. It must be expanded to include the process to be followed when a member of staff is given money for a resident. It must also include the procedure to be followed when the registered manager is not in the home. The registered manager has opened a bank account to hold residents money, he keeps individual records on his computer and receipts are kept in a drawer. The records of all transactions must be handwritten with two signatures provided to prevent abuse of the system. Pocket money held for residents in the home must be stored individually so that it is safe and can be checked during inspections. At present the petty cash is used with insufficient records maintained. The registered manager said a copy of the resident’s record is available to the family on request. A relative paid in a cheque during the inspection she received a receipt and a copy of the resident’s printed computer record. Day to day supervision of staff appears to be satisfactory. Care staff appear to be supervised by the nursing staff. There is little evidence of a formal one to one supervision system in operation. One of the staff files inspected had a copy of notes of two formal supervision sessions of which the last was some months ago. The home has a health and safety policy. A health and safety audit was completed by an external organisation and lists a significant number of requirements. Although the audit was competed in June 2005 there appears to have been little progress regarding making the required changes. The Commission previously requested an action plan and this has not been provided. Health and safety records were inspected. A health and safety risk assessment has been completed but this needs to be dated, and reviewed at least annually. A fire risk assessment is also in place (dated 10/2003). Staff have not tested fire alarm call points and emergency lighting in accordance with guidance by the fire authority. However external contractors are testing emergency lighting and the fire system and a contract for servicing the fire alarm and lighting is in place. Records show fire extinguishers were last serviced in August 2005. Cowbridge Nursing Home DS0000009169.V293718.R01.S.doc Version 5.1 Page 25 There are insufficient records that the lift is serviced. A contractor was last called out in July 2005 to fix the lift when it broke down, but the registered manager was not aware whether there was a service contract or when the lift was last serviced. The registered provider has five hoists. The registered manager said all but two were under twelve months old and did not require servicing. There was evidence that two of the hoists were serviced once since August 2005. The external health and safety audit states there is no temperature control of hot water. No temperature records are kept of bathwater. This could present a significant danger in a care home for people with dementia / mental disorder. There is no policy regarding the prevention of Legionella and no risk assessment is in place regarding this. However Restormel Borough Council has completed a test, and the results of this were satisfactory. Portable electrical appliances were last tested in October 2005. There is no evidence the electrical hardwire test has been completed. By law this must be completed every five years. There is no evidence the boiler or gas appliances have been serviced. By law these must be serviced at least annually. The home has a moving and handling policy. This is fairly basic. Manual handling risk assessments are very basic and require improvement. Staff were observed inappropriately handling one resident. The footrests were removed from at least one wheelchair, which could result in serious injury to the resident concerned. There is little evidence that staff have received appropriate health and safety training. This is documented in full in the previous section of the report. Cowbridge Nursing Home DS0000009169.V293718.R01.S.doc Version 5.1 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 2 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X 1 X X X 2 2 STAFFING Standard No Score 27 3 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 2 2 X 1 Cowbridge Nursing Home DS0000009169.V293718.R01.S.doc Version 5.1 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 2 3 Standard OP1 OP7 OP7 Regulation 6 15 15 Requirement The statement of purpose must be reviewed and updated Each resident must have a written care plan that is available to care staff Individual care plans must be drawn up and reviewed with the resident and /or representative whenever possible and signed as agreed. 5th Notification There must be an indication as to how risk assessments are scored and the actions to be taken must be recorded to direct staff Relevant risk assessments must be undertaken for each resident and there must be a specific risk assessment undertaken for those at risk of falling The pressure sore policy must be reviewed and updated Medicines policy must be further reviewed and updated. Medicine practices must improve: • All transcribing onto the MAR charts must be witnessed with two signatures recorded DS0000009169.V293718.R01.S.doc Timescale for action 07/08/06 07/08/06 07/08/06 4 OP7 13(4)(c ) 07/08/06 5 OP7 12 07/08/06 6 7 8 OP8 OP9 OP9 12(1) 13 13 07/08/06 07/08/06 01/06/06 Cowbridge Nursing Home Version 5.1 Page 28 9 10 OP18 OP19 11 OP19 12 OP10 13 OP21 14 OP22 Anything prescribed for an individual must not be administered to anyone else • All medicines must be disposed of appropriately and recorded 12 The home’s adult protection policy must be reviewed and updated. 3rd notification 13,23 Following the health and safety consultation in respect of the premises, the Registered Provider must forward an action plan to CCSI on how it will address the issues raised. Second notification 16, 23 The registered provider must provide the Commission with an action plan for the complete refurbishment of the building (e.g. redecoration, replacement of furnishings and carpets, replacement of bedroom furnishings etc. as required.) The plan must include timescales for action. 13, 16, 23 The registered provider must: (a) Remove the external bolts from bedroom doors as a matter of urgency (b) Provide bedrooms (as appropriate) with a suitable locking device. 16, 23 The registered provider must improve bathing facilities throughout the home. The registered provider must provide the Commission with an action plan outlining what improvements will be made giving suitable timescales. 13,23 All wheelchairs must be in correct working order and have foot rests attached to ensure safety when moving residents around the home. 3rd notification DS0000009169.V293718.R01.S.doc • 07/08/06 05/06/06 01/09/06 01/09/06 01/09/06 08/06/06 Cowbridge Nursing Home Version 5.1 Page 29 15 OP24 16, 23 16 17 OP25 OP26 18 OP29 19 OP19 20 21 OP29 OP30 The registered provider must attend to the following: • Replace carpets in bedrooms 23 and 9. • Attend to peeling wallpaper in bedrooms 22 and 29. • Attend to the serious crack in the wall in bedroom 29. 23 Improve ventilation in the building e.g. office 13, 16, 23 The registered manager must use an alternative cleaning material to the current disinfectant to improve the smell in the home. 13, 19 The registered person must ensure all new staff have a Criminal Records Bureau check applied for prior to employment. 13, 17, 19 New staff must not commence work until two satisfactory references and POVA check have been received. 17 Recruitment records required by legislation must be maintained. 4th notification 18 The registered persons must provide staff with suitable training: (1) As required by regulation such as fire training, first aid (as applicable), food hygiene (as applicable), infection control and manual handling. (2) There must be evidence that all staff that commence employment have received an appropriate induction. (3) All staff who handle medication must have suitable external training (4) All staff must have training regarding people with mental DS0000009169.V293718.R01.S.doc 01/09/06 01/09/06 01/06/06 15/05/06 15/05/06 06/06/06 01/11/06 Cowbridge Nursing Home Version 5.1 Page 30 22 OP30 13 23 OP35 13(6) 24 25 26 27 28 OP35 OP35 OP36 OP37 OP38 13(6) Sch 4 13(6) 18 17 23 29 OP38 13, 23 health needs and dementia (5) There must be evidence staff have received induction and training (e.g. induction checklist and copies of training certificates). All staff must attend training in the management of challenging behaviour and restraint techniques. The policy for resident’s money must be reviewed to include the action to be taken by staff when handed money on behalf of residents and the procedure to be followed in the absence of the registered manager. Records of all resident’s money transactions must be recorded with two signatures provided Pocket money held for residents in the home must be stored individually and accounted for All staff must be provided with formal one to one supervision at least six times a year All records required by legislation must be kept in the home. 3rd notification There must be adequate changing facilities for staff (a separate facility for catering staff) with lockable storage for personal belongings. 3rd notification The registered provider must ensure there are suitable health and safety precautions: (1) Fire alarm call points and emergency lighting must be tested at intervals recommended by the fire officer. (2) There must be suitable records of the testing of the fire alarm system DS0000009169.V293718.R01.S.doc 07/08/06 07/08/06 07/08/06 07/08/06 01/11/06 08/06/06 30/07/06 01/09/06 Cowbridge Nursing Home Version 5.1 Page 31 (3) (4) (5) (6) (7) and fire extinguishers by external contractors, at suitable intervals recommended by the fire authority. An electrical hardwire test must be completed at least every five years 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. There must be a service contract for the lift, and other moving and handling equipment. This equipment must be serviced regularly in line with the manufacturers recommendations. The temperature of hot water must be restricted e.g. on baths / showers. Records must be kept to test the temperature of hot water and any thermostatic valves fitted. The boiler and any gas appliances must be tested at least annually, and a gas safety certificate obtained. 01/09/06 30 OP38 13, 16, 23 Outbuildings must be made secure to minimise any risks to residents and visitors Cowbridge Nursing Home DS0000009169.V293718.R01.S.doc Version 5.1 Page 32 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 4 5 6 7 8 9 Refer to Standard OP2 OP3 OP7 OP7 OP8 OP9 OP9 OP16 OP19 Good Practice Recommendations All residents should have a signed contract with terms and conditions of residency. The initial assessment document should state who is involved in the assessment and the document should be fully completed All of the care documentation for an individual resident should be held in one file. Individual life histories should be compiled for each resident There should be written consent gained for any form of restraint used All residents should have a photograph held with their MAR chart The temperature of the drug fridge should be monitored and recorded regularly, for example weekly The complaints policy should be amended to make reference that expressions of concern can be made to CSCI at any time. Registered Provider should seek the advice of other agencies that specialise in the provision of facilities and services for people with dementia, particularly those involved with environmental design. There needs to be a review of the bathing facilities in the home to ensure they are suitable for the residents accommodated. There needs to be a sluice with a washer disinfector upstairs. 10 11 OP21 OP24 Cowbridge Nursing Home DS0000009169.V293718.R01.S.doc Version 5.1 Page 33 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 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.V293718.R01.S.doc Version 5.1 Page 34 - 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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