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Inspection on 28/03/08 for Cowbridge Nursing Home

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

This inspection was carried out on 28th March 2008.

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

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

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

The home has suitable information available, about the home, for enquirers and prospective residents. The manager or a qualified nurse from the home assesses each person admitted to the home. Assessments from external agencies are also acquired prior to admission of a resident. Each person has a detailed care plan that is being further developed to inform and direct staff in how to care for them. The people using the service appear to have their personal care needs addressed appropriately for instance they appear clean, dressed well and appropriately and receive suitable portions of nutritious food.Staff appear to be caring and show compassion and concern regarding resident`s needs. There is good communication with GP`s and other healthcare professionals. The home is warm and clean with no unpleasant odours. There are suitable laundry facilities and people were observed wearing clean clothes. There is a suitable system in place for the safekeeping of people`s money. The management team have a positive approach to improving the home and are endeavouring to address the requirements set by the Commission for Social Care Inspection.

What has improved since the last inspection?

This home has an improvement plan in place and the registered provider has taken action to comply with the requirements set at the last inspection. Some of the requirements have not been fully met and the dates for compliance have been adjusted to reflect those agreed in the improvement plan. The statement of purpose has been updated and terms and conditions of residency have been reviewed for each person. The new style care plans have been implemented and are a vast improvement. Activities have been developed and there are plans to further develop these. Care staff now have a handover at the beginning of shifts to get updated on what has happened previously. This has addressed the concerns staff raised in recent CSCI surveys. Abuse training for staff has been taking place and should be completed by May 2008. The abuse policy has been reviewed and updated ready for implementation. People are now free to move around the building as restrictions such as keypads and locks have been removed. The premises have been further improved by decoration and maintenance work being done. CSCI have been sent a plan for the repair and maintenance of the home. There are plans for various other work to take place soon including the provision of a wet room shower and the installation of UPVC windows. Training has improved and a plan is now in place for this year, staff are very appreciative of the new programme. Quality assurance is being addressed with satisfaction surveys sent to relatives, meetings commencing with staff and audits planned.Management arrangements have improved along with staff morale. All staff seem to be very happy working in the home.

What the care home could do better:

The risk assessment process for any restraint used in the home has not been properly addressed; the manager has guidelines and information available and must get this done as soon as possible. The system for medicines requires attention in respect of care planning and communication. One of the storage cupboards needs to be replaced, as it does not comply with current legislation. More care needs to be taken to ensure the daily records contain sufficient detail as they are legal documents and could be used as evidence. The activities records need to be more detailed to state the involvement of the person and any emotional reaction for example. Interview records should be kept to improve the recruitment process and photographs, health checks and details of the job need to be kept. A registered manager would bring the home more continuity and leadership. Policies should state what the procedures actually undertaken in the home. Those policies identified at this inspection include quality assurance, accidents and resident`s money.

CARE HOMES FOR OLDER PEOPLE Cowbridge Nursing Home Rosehill Lostwithiel Cornwall PL22 0JW Lead Inspector Diana Penrose Unannounced Inspection 28th March 2008 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cowbridge Nursing Home DS0000009169.V360524.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.V360524.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 Position Vacant 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.V360524.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 15/08/07 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 people using the service. 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 sitting rooms and a dining room. Refurbishment is currently taking place. Information about the home is available in the form of a statement of purpose and 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 £478.67 to £600 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.V360524.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. An inspector visited Cowbridge Nursing Home on the 28th March and 31st March 2008 and spent nine and three quarter hours at the home. The pharmacist inspector visited the home on 14th March 2008 and spent two and a half hours at the home, his evidence is included in this report. 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 15 August 2007. A random inspection took place on 25th January 2008 to gain an update on the home’s improvement plan, which was progressing well. On the day of inspection 26 people were living in the home. The methods used to undertake the inspection were to meet with 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 inspector toured the building. CSCI have received completed surveys from 2 residents, 2 relatives, 10 staff and 1 healthcare professional and these have helped to inform this inspection. All of the key standards were inspected. This report summarises the findings of this inspection. There is still no registered manager employed and this has an impact on the management of the home and leadership of the staff team. Jean Bennett is the Interim Manager and has developed systems for improvement with the assistance of an Operations Manager; who was employed for a short time. What the service does well: The home has suitable information available, about the home, for enquirers and prospective residents. The manager or a qualified nurse from the home assesses each person admitted to the home. Assessments from external agencies are also acquired prior to admission of a resident. Each person has a detailed care plan that is being further developed to inform and direct staff in how to care for them. The people using the service appear to have their personal care needs addressed appropriately for instance they appear clean, dressed well and appropriately and receive suitable portions of nutritious food. Cowbridge Nursing Home DS0000009169.V360524.R01.S.doc Version 5.2 Page 6 Staff appear to be caring and show compassion and concern regarding resident’s needs. There is good communication with GP’s and other healthcare professionals. The home is warm and clean with no unpleasant odours. There are suitable laundry facilities and people were observed wearing clean clothes. There is a suitable system in place for the safekeeping of people’s money. The management team have a positive approach to improving the home and are endeavouring to address the requirements set by the Commission for Social Care Inspection. What has improved since the last inspection? This home has an improvement plan in place and the registered provider has taken action to comply with the requirements set at the last inspection. Some of the requirements have not been fully met and the dates for compliance have been adjusted to reflect those agreed in the improvement plan. The statement of purpose has been updated and terms and conditions of residency have been reviewed for each person. The new style care plans have been implemented and are a vast improvement. Activities have been developed and there are plans to further develop these. Care staff now have a handover at the beginning of shifts to get updated on what has happened previously. This has addressed the concerns staff raised in recent CSCI surveys. Abuse training for staff has been taking place and should be completed by May 2008. The abuse policy has been reviewed and updated ready for implementation. People are now free to move around the building as restrictions such as keypads and locks have been removed. The premises have been further improved by decoration and maintenance work being done. CSCI have been sent a plan for the repair and maintenance of the home. There are plans for various other work to take place soon including the provision of a wet room shower and the installation of UPVC windows. Training has improved and a plan is now in place for this year, staff are very appreciative of the new programme. Quality assurance is being addressed with satisfaction surveys sent to relatives, meetings commencing with staff and audits planned. Cowbridge Nursing Home DS0000009169.V360524.R01.S.doc Version 5.2 Page 7 Management arrangements have improved along with staff morale. All staff seem to be very happy working in the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cowbridge Nursing Home DS0000009169.V360524.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cowbridge Nursing Home DS0000009169.V360524.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. There is satisfactory information about the home available to residents and their families; this helps people to decide if the home is right for them. People are fully assessed prior to admission to the home to ensure their needs can be met. EVIDENCE: The home has a suitable statement of purpose that has recently been updated. The document is available in the home and given to prospective residents or their families. The service user guide has been updated and the manager stated that a copy has been sent to the families or the representatives of the residents accommodated. The manager stated that resident’s relatives are given a copy of any contract provided by the department of adult social care. She said the home’s terms and conditions of residency are under review by the Operations Director and each resident will receive a copy. One document for a new resident was Cowbridge Nursing Home DS0000009169.V360524.R01.S.doc Version 5.2 Page 10 available for inspection and it detailed the fees more fully including the nursing contribution separately. Contracts provided by the department of adult social care were seen in the resident’s files. The manager said that she or a suitably qualified nurse visits prospective residents prior to their admission to the home. Assessments for new residents, including that of the most recent resident admitted, were inspected and had been undertaken by a suitably qualified nurse. Appropriate information was recorded and they were dated and signed by the nurse. Assessments from the department of adult social care and NHS nurses were also held in the care files. Cowbridge Nursing Home DS0000009169.V360524.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each person using the service has a care plan, some additions, further attention to medicine procedures and risk assessment will improve the system to safeguard vulnerable people. EVIDENCE: The new style care plans have been fully implemented and are a vast improvement on the previous system. They appear to be detailed to inform and direct staff in the care to be provided. Care planning in respect of medicines needs to be addressed to ensure staff are fully informed. There are various risk assessments included with the care documents and one nurse has been made responsible for making sure these are referred to in the written care plans. The risk assessments for restraint are poor and not in enough detail to specify the risks to the individual. The manager now has guidelines in respect of restraint and the use of bed rails. She said she would read the paperwork and address this issue. Information regarding the person’s previous life history and interests is being sought from relatives and friends this will help the home to provide a life that is suited to the individual residents as Cowbridge Nursing Home DS0000009169.V360524.R01.S.doc Version 5.2 Page 12 much as possible and enable staff to relate to them better. The daily records are completed each day and night, some entries are much more descriptive and give a better record of events than others. The records we saw were variable in content. Care plans were signed by relatives and the manager spoke to a relative on the telephone during the inspection and discussed a care plan. This person then visited the home to discuss further with the manager. We found that some people were having their medicines administered either covertly or in mousse. When this was discussed with the member of staff they told us that this had been included in the plan of care. However when we looked at the plan of care for one person having medicines administered in mousse we could find no record of this having been agreed. Also for a person having their medicines crushed and administered covertly there was again no record of this in their plan of care. We found that for one person having regular insulin injections that no record is made of the injection site, which means that problems relating to the absorption of the drug may occur. Also for this person there was an instruction in the care plan to indicate that action was to be taken if their blood sugars levels were above a certain level but there was no guidance available of action to take if they had a low blood sugar reading. On speaking to the nurse in charge she was aware of current guidance relating to blood sugar levels and action to take. For people prescribed to have medicines administered “when required” we found that although this medicine was administered regularly there is no record made of any assessment made before the administration of the medicine. We also found that there is no reference made in the care plan about the use of this medicine, nor are there any directions on how to make an assessment if this medicine is required. We found that whilst the home record the receipt of most monthly medicines the records made when medicines are received outside of this regular cycle that records of receipt are not always made. This means that it is not always possible to audit the medicines in the home. The home has made arrangements for the safe storage of medicines, although one of the cupboards in use did not appear to comply with the current regulations. We also observed that other valuables were being stored in the medicines cupboards which is considered to be poor practice as it encourages increased access to the medicines storage and also may mean that the home does not have a full audit trail of people’s possessions. We found that the home have in place a system for the safe storage of medicines requiring refrigeration, and that the temperature is maintained within the recommended range. Cowbridge Nursing Home DS0000009169.V360524.R01.S.doc Version 5.2 Page 13 There was evidence within the care documentation of visits by healthcare professionals and one CSCI survey was received from a doctor who visits the home. 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 and there are records to show that the community tissue viability nurse specialist visits the home. One nurse has taken on the role of tissue viability link for the home and said she will be attending training soon. She showed us the records held which were kept up to date. The manager stated that a senior care would be taking on the role of continence link for the home. We saw that resident’s privacy was respected during the inspection and they were free to move around the home. Although exits are locked, residents can move around the downstairs or the upstairs areas. The kitchen, staircase and staff only areas are restricted. One shared bedroom still lacks screening but there is only one person using the room. The manager said this would be addressed if two people use the room. Cowbridge Nursing Home DS0000009169.V360524.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities are improving and staff aim to respect individual’s wishes and needs by providing choices and flexibility in the daily routines. They are liaising with relatives to provide a lifestyle suited to the individual. A nutritious diet is provided. EVIDENCE: There is a realistic policy in respect of activities and as stated previously families are being consulted about the social interests of their relatives in the home. One person is responsible for the organisation of activities and was working during the inspection. She was enthusiastic in her role and interacted well with the people using the service. A group of people were drawing and chatting with her, one said he enjoyed the sessions. Other staff were walking with people and two were looking at magazines and reminiscence books with people in the lounge. There was a programme of events displayed in the dining room and include chair exercises, holy communion, reminiscence and various 1:1 activity. The individual records lack detail about the persons response to activities and this was discussed with the manager and activities co-ordinator who said they would modify them. Staff have commented that there are a lot Cowbridge Nursing Home DS0000009169.V360524.R01.S.doc Version 5.2 Page 15 more activities now and they enjoy them too. The manager said they are hoping to arrange trips out when they get transport organised There is monitoring of the times that residents get up and go to bed, which shows it is variable and not set. One person said he is free to do as he likes each day and he said there are choices at mealtimes. Freedom of movement around the building has improved and several people were walking around. At present there is one mobile resident upstairs and staff are locking the fire door to the stairs for her safety. It has been risk assessed and documented in her care plan that another fire door can be used. Fire doors must not be locked and the fire authority must be consulted if this is to be considered. The manager said this resident spends her day downstairs and hopes to move to a room downstairs when one is available. The mealtime arrangements are satisfactory, the dining room is now in use and there is also a dining table in one lounge. Only eleven people were sitting to tables to eat their lunch, others were in armchairs with small tables in the lounge and some were in their rooms. Choices were offered at lunchtime and staff support during the observed mealtime was good. Nutritional needs are assessed and documented in the care files. The menu is nutritional and wholesome, homemade cakes are provided every day and there are fresh vegetables and fruit available. One survey stated that the food is very bland with sponge and custard being served 3-4 times a week. The cook and other members of staff said that residents really enjoy the sponge puddings. All other comments regarding food were positive and the lunchtime meal appeared to be enjoyed. Cowbridge Nursing Home DS0000009169.V360524.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 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, which should ensure complaints will be listened to and acted upon. Arrangements are in place for the protection of residents from abuse, however the policy is new and further staff training has to take place EVIDENCE: The home has a suitable complaints policy and a method for recording complaints. There have been no complaints received by the home since the last inspection. There has been one concern regarding the restraint of residents voiced by a care manager, which has been resolved. The abuse policy has just been reviewed and updated and gives more specific guidelines for staff. It has not yet been made available to staff. Some staff have received abuse training, the operations director said he has arranged further training for April 2008. The abuse allegations referred to in the last key inspection report have been dealt with. There is one current adult protection issue being investigated by the police. Cowbridge Nursing Home DS0000009169.V360524.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22 and 26 Quality in this outcome area is adequate. 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 and more improvements have been made to the decoration and facilities. It now looks more homely, comfortable, clean and safe. There is a plan in place for decoration and maintenance, which includes the improvement of bathing facilities. EVIDENCE: CSCI staff surveys show that they are concerned about the state of the building, furniture and furnishings. CSCI have been sent a plan for the repair and maintenance of the home and the premises continue to be improved to make it a more comfortable and homely place to live and work in. All of the downstairs bedrooms have been decorated and the handyman said he is going to do the corridors next. He has been working on the staff facilities and thermo plastic flooring is going to be laid in that area. He said he has to start on the outside of the building when the weather improves. Cowbridge Nursing Home DS0000009169.V360524.R01.S.doc Version 5.2 Page 18 People from a double-glazing company visited during the inspection. The operations director stated that all of the big windows at the front of the house are to be replaced with UPVC windows. Repairs were imminent to room 21, as was the plastering of the corridor upstairs where the wall has been damaged by water getting in from the roof. The manager stated that the wet room is to be completed by 30/04/08. Staff spoken with during the inspection said this would be a wonderful addition to the home and enable people to be washed more easily. They said the bath upstairs with the chair hoist has made their work a lot easier. A new boiler has recently been installed as the heating stopped working. The hot water pipes upstairs have been boxed in but the wood still needs to be painted. The manager said that electrical systems are being checked including the call system boxes, some new lighting has been provided. The door at the bottom of the stairs is locked to prevent residents accessing the stairs, which could compromise their safety. The use of high handles or an alarm system was discussed at a random inspection in January 2008 when a recommendation was made to review the system in place. The registered provider has told the Commission that the communal space is 129sq m, this equates to 4.3sq m per person when the home is fully occupied. This is a reduction in the original space but more than that recommended in the National Minimum Standards. The space now utilised as an office has meant that the manager has a private place to work, it has improved the storage for confidential documents and staff facilities in the home. The home was clean and hygienic on the day of the inspection and there were no unpleasant odours. A sluice facility is provided downstairs but a sluice has not yet been provided upstairs. All laundry is dealt with in house, there is suitable equipment provided but the room is very small and noisy. Suitable protective clothing is provided for staff and they were seen using disposable gloves and aprons. Hand-washing facilities are satisfactory. The operations director has stated that all staff needing infection control training are booked on courses in May 2008, the home’s training matrix shows that eighteen staff are due to attend. Cowbridge Nursing Home DS0000009169.V360524.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are adequate and recruitment is in progress to ensure there are sufficient staff as more people are accommodated. There has been an improvement in the recruitment process and a training plan has been implemented for staff so that the home has suitable staff with the appropriate knowledge to care for people safely. EVIDENCE: The staffing rota shows that a qualified nurse is on duty at all times, sometimes there are two, either a Registered General Nurse (RGN) or a Registered Mental Nurse (RMN). The skill mix has improved since the last inspection there are now 3 RMNs and 5 RGNs on the rota. There is also an oncall rota that includes some RMN cover. There has been no assessment of the competency of these nurses to work with people with mental health needs and be left in charge of up to 30 residents. The manager showed us suitable documentation she intends to use to assess the competency of nurses. The improvement plan states that this will be completed by 30 April 2008. Care staff work 12-hour shifts, there are 4 carers by day and 2 at night. The manager said she is hoping to increase the day number to 5 now that more people are accommodated. Cowbridge Nursing Home DS0000009169.V360524.R01.S.doc Version 5.2 Page 20 CSCI staff surveys include the comments “If nights are short we have to cover leaving days short”, “There are not always sufficient staff” and “It would be nice to have full staff all the time and not have day staff taken to do nights leaving day staff short”. The manager acknowledged the problems and said she has been advertising for posts, she showed us application some application forms received. She does not feel the staffing levels have compromised the care provided. Staff morale has improved since the last inspection and staff spoken with are happy working in the home. They all said they work well as a team and that the atmosphere is relaxed and cheerful. Survey comments include “Staff relationships appear to be good”, “Very good interaction between staff and residents”, “The home has improved greatly in recent months and all staff are marvellous” and “The current staff mix is one of the best I have worked with”. The manager said that 15 of the 16 care staff have an NVQ qualification. 5 are qualified to level 3 and two more staff hope to do the level 3 course. The staff files for the three newest employees were inspected, all had an application form but two had no health check and there were no photographs of the employees. The manager said she would address these. All of the other required documents were held. One person had a conviction on their CRB disclosure (and declared on the application form), interview records are not kept and there is no evidence that this has been acknowledged or discussed with the person. Induction records were complete and there were supervision and appraisal records in two files. The operations director has supplied the Commission with a copy of the home’s training matrix, which shows that training for staff is improving. However training updates are needed for some staff in respect of infection control, fire safety, health and safety and abuse. Any staff that handle food must undertake food hygiene training; at present 10 staff have done this. The operations director has stated that abuse training will take place in April, moving and handling training has been booked for all staff in May 2008, all staff will receive a fire awareness training refresher by July 31 2008, those staff last trained on infection control in 06 will be allocated to the courses on 19 and 22 May, two health and safety courses have been arranged for June 2008 to bring all up to date, the manager and the activities co-ordinator will update their POVA training in May 08. Mental health awareness training is booked for May 2008 as well. Restraint techniques are not included in the matrix. There were relevant training certificates on the files inspected. Cowbridge Nursing Home DS0000009169.V360524.R01.S.doc Version 5.2 Page 21 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, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management arrangements have improved but a registered manager is required for continuity and leadership for the staff. Better systems have been put in place, or are being developed, so residents can have a good quality of life and be assured that they live in, and staff work in, a safe environment. EVIDENCE: The registered manager’s post has now been vacant for a significant period of time. The registered provider is still actively trying to recruit a new manager, when a person is appointed they will 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 permanent manager is employed. The registered provider employed an Cowbridge Nursing Home DS0000009169.V360524.R01.S.doc Version 5.2 Page 22 operations manager for a short period to assist with administration and the development of systems in the home. She made many positive changes and it is hoped that the team will progress with these now that she is no longer employed. The manager and the operations director seem keen to develop the service and bring about change. They also seem to have a positive ethos to the care of the elderly. During the inspection staff spoke positively about the manager and the operations director and said they feel supported and can air their views. However they feel a permanent manager is needed to bring stability to the home. CSCI survey comments include “We love this home but we do need a manager who is strong and will act on our concerns promptly and get this shabby place decorated and furnished”, “There has not been a regular culture of improvement in terms of acquiring skills to deal with more challenging physical needs” and “They need better strategic planning. There has been a succession of managers without the required skills. Currently there is a very able acting manager, but with no RMN training”. There is a quality assurance policy in place but it needs to reflect the actual practice. A survey has been undertaken with relatives and received a positive response. There are a number of letters from relatives expressing their satisfaction with the care provided. CSCI survey results were also positive about the service. A quality assurance meeting has taken place with resident’s relatives and representatives; the manager said she hopes to make this a regular occurrence. There are minutes of staff meetings in a file, the meetings are not held regularly. There has been a recent nurses meeting. Management meetings are held regularly with an action plan included in the minutes. The operations director, in compliance with legislation, visits the home each month and sends reports to the Commission. The manager said there are often smaller meetings that don’t get documented. There is no auditing system in place. The manager said that the accident reports are to be audited by the operations director and she is going to audit the medicine records. There is a policy for the safekeeping of resident’s money it needs to include the actual processes carried out in the home. No one controls their own money. Money is held in individual plastic wallets in the safe. There is no mention in the policy as to how much money can be held for each person. Receipts are kept for purchases and money received but they are not held in any particular order. Cheques are sent to the company’s head office to be cashed, there are tracking forms in the records. One person signs the balance sheet, usually the manager; it is recommended that two people check the records sometimes to ensure they are correct. The records and money held for two people were checked and found to be correct. Cowbridge Nursing Home DS0000009169.V360524.R01.S.doc Version 5.2 Page 23 The registered provider has a health and safety policy and external audits take place. Fire equipment has been tested including the emergency lighting. An approved contractor has serviced moving and handling equipment. There is a suitable risk assessment in place for the prevention of Legionella. The passenger lift is in working order and the manager said the registered provider is still considering whether a replacement is feasible. Hot water temperatures are being recorded prior to residents bathing and has been at suitable levels. Hot water pipe work has been boxed in, but the wood needs to be painted. The manager said that thermostatic valves have been fitted to hot water outlets in bathrooms and some hand basins. She thought that all were to be done eventually. Accident reports are maintained and accidents are also recorded in the daily records. There are 19 reports for February 2008 and 18 reports for March 2008. During an adult protection investigation the records showed that accident reporting was not carried out consistently or in compliance with legislation. In one instance an accident report was completed retrospectively and not by the person witnessing the accident. Another accident was not reported, there was merely an entry in the daily records. A requirement was made that all accidents in the home must be reported appropriately. The operations director states they are now complying with this. The home’s accident policy is due for a review. There is no evidence that accidents are investigated or that incident forms are in use as stated in the policy. There is still no evidence that a risk assessment takes place or that care plans are reviewed following accidents in the home. The Commission has received notifications of deaths and injuries in accordance with regulations 37 reporting. The manager stated that all occurrences have been reported since the last inspection. Cowbridge Nursing Home DS0000009169.V360524.R01.S.doc Version 5.2 Page 24 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 3 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 2 X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Cowbridge Nursing Home DS0000009169.V360524.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP2 Regulation 5A Requirement The home must provide, to each nursing resident or their representative, an accurate statement regarding the fees payable and must state the nursing contribution separately. This will ensure they are fully informed. (2nd notification, previous timescale of 31/03/08 not met) 2 OP7 13 (7) (8) The home’s risk assessment for the use of restraint must be reviewed to specify the risks to individuals and the action to be taken by staff. This will ensure the resident’s welfare is safeguarded. Arrangements must be made to ensure that all medicines are stored in accordance with the current regulations Arrangements must be made to ensure that the use of covert administration and crushing medicines is included in the care plans for the individuals and that this is only carried in accordance DS0000009169.V360524.R01.S.doc Timescale for action 31/05/08 01/06/08 3 OP9 13(2) 01/07/08 4 OP9 13(2) 01/06/08 Cowbridge Nursing Home Version 5.2 Page 26 5 OP9 13(2) 17(1) 6 OP18OP18 13(6) with the principles of the Mental Capacity Act Arrangements must be made to ensure that there is an accurate and up to date record of all medicines received into the home. All staff must undertake training regarding abuse so they can be competent in their role of safeguarding the residents. (2nd notification, timescale now in line with the improvement plan) Bathing facilities must be reviewed and specialist baths or wet room shower facilities included as necessary. This will enable the elderly frail residents to be bathed safely and comfortably. 12/05/08 30/04/08 7 OP21 23 30/04/08 8 OP19 16, 23 (4th notification, timescale now in line with improvement plan) The home must be of sound 30/09/08 construction, well maintained and reasonably decorated to ensure that residents live in a safe environment that meets their needs. (4th notification timescale now in line with improvement plan) Staff must be deemed competent in their roles and nurses competency must be assessed and documented in respect of working and being in charge of mentally ill people. This will safeguard the residents accommodated. (2nd notification, previous timescale of 31/03/08 not met) 9 OP27 18 01/09/08 10 OP30 18 (1) (c) 23 (4) (d) All staff must receive training appropriate to their role DS0000009169.V360524.R01.S.doc 31/08/08 Page 27 Cowbridge Nursing Home Version 5.2 including: • The management of restraint techniques. • Fire training, first aid, food hygiene, infection control and moving and handling. • Medication training • Abuse and protection • Mental health illnesses and dementia This will help to ensure that staff are competent and safe to work with vulnerable people. (4th Notification, timescale now in line with the home’s development plan) 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 Refer to Standard OP7 OP9 OP19 OP24 OP33 Good Practice Recommendations Individual life histories should be compiled for each resident so that staff have a better understanding of how to care for them and communicate with them. It is recommended that when members of staff are administering insulin injections that they record the injection site, to prevent problems with the absorption of the insulin. The locking of the door at the bottom of the stars should be reviewed to improve the access for residents, as appropriate, staff and visitors. A sluice with a washer disinfector should be provided upstairs for infection control purposes. Policies should reflect the actual practice to be undertaken, so that staff know what is expected of them, this includes quality assurance, accidents and resident’s money Cowbridge Nursing Home DS0000009169.V360524.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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.V360524.R01.S.doc Version 5.2 Page 29 - 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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