CARE HOMES FOR OLDER PEOPLE
Cowbridge Nursing Home Rosehill Lostwithiel Cornwall PL22 0JW Lead Inspector
Lynda Kirtland Unannounced Inspection 6th March 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cowbridge Nursing Home DS0000009169.V273131.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.V273131.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.V273131.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). 16th August 2005 Date of last inspection Brief Description of the Service: Cornwallis Care Services Ltd, own two nursing homes in Cornwall one of which is Cowbridge. The same director has Porthia Group Ltd and owns a residential care home also in Cornwall. Cowbridge Nursing Home is registerd to provide accomodation and care to 30 residents of which some may experience mental health or dementia . The registered manager Mr Herren, has been in post for approximately thirteen months. 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 that is enclosed and 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 facilities are provided. All rooms have call bells. There are three non-smoking sitting rooms and a separate dining room. Cowbridge Nursing Home DS0000009169.V273131.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 6 March 2006 and spent four hours at the home. This was an unannounced visit. The purpose of the inspection was to gain an update on the progress of compliance to requirements identified in the last inspection report dated 16 August 2005 and the last joint visit to the home on 09 November 2005. At that visit the registered manager had complied with 7 requirements and one was being considered. There were however 2 immediate requirements identified for action one of which has not yet been addressed. In addition the inspectors focused on the following key areas of care: choice of home, assessment and care planning, complaints, adult protection, some of the environment, training, resident’s money and record keeping. On the day of inspection 29 residents were living in the home. The methods used to undertake the inspection were to meet with the registered manager to gain his view on the services offered by Cowbridge Nursing Home. Records, policies and procedures were examined. This report summarises the findings of this inspection. Due to unforeseen circumstances the inspection had to finish earlier than anticipated. The home has received regular monitoring visits and the inspectors have looked at all of the core standards over the past year. They have spoken to staff, residents and visitors during their visits. What the service does well:
The registered manager undertakes a thorough assessment before a new resident is admitted to the home. He also obtains information from other healthcare professionals as necessary. Care staff are encouraged to undertake NVQ training and the registered manager stated that all care staff employed have either achieved the qualification or are studying towards it. 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.V273131.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
This inspection focussed on the 19 requirements and 8 recommendations identified at the last inspection and updated at the last monitoring visit. Eight requirements have been addressed, the remaining eleven have been renotified and ten others identified. Two recommendations have been addressed and six re-notified along with three others identified. 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 home is clean and tidy attention must be given to eliminate the strong unpleasant smell of disinfectant that is noticeable on entering the home. Toilets in the home must be fitted with appropriate locks and paper hand towels should be available. 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.
Cowbridge Nursing Home DS0000009169.V273131.R01.S.doc Version 5.1 Page 7 Further work is required on some of the home’s policies to ensure they state clearly what the home expects to achieve and the actions to be taken by staff. Record keeping in the home must improve to ensure that relevant records are maintained and legislation complied with. Some of the requirements and recommendations from the last visit were not reviewed during this inspection but will be at the next visit. They are therefore re-notified. 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.V273131.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.V273131.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 and 3 Prospective residents are given information about the home but it does not enable them to make a fully informed choice of home. Each resident has a written contract and terms and conditions of residency so they and their representatives know what to expect from the home. Residents are only admitted to the home following an assessment of their needs to ensure the home can provide adequate care 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 range of needs requires expansion and there must be information as to how residents or their representatives are consulted on the operation of the home. Information regarding review of the care plans, therapeutic techniques, room sizes and privacy and dignity must be included. These areas were discussed with the registered manager at the last inspection. The registered manager said that all residents now have a Cowbridge contract. The resident or their representative had signed the contracts inspected.
Cowbridge Nursing Home DS0000009169.V273131.R01.S.doc Version 5.1 Page 10 The registered manager said he visits prospective residents, 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. Assessments are signed and dated by the registered manager. It is recommended that the assessment document also states who is involved in the assessment. The registered manager said he obtains Social Services assessments if applicable and some were seen, he also obtains information from hospital staff when appropriate. One resident did not have a written preadmission assessment and this was discussed with the registered manager. Cowbridge Nursing Home DS0000009169.V273131.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 and 8 Individual care plans are generated for each resident but do not fully inform and direct the staff in their care provision. 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. EVIDENCE: The care plans are held individually 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. The care plans have been further developed since the last inspection but 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. 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.
Cowbridge Nursing Home DS0000009169.V273131.R01.S.doc Version 5.1 Page 12 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. Relatives had provided a life profile for one resident which was very informative. These should be compiled for all residents, to inform staff and enable them to provide appropriate care. Residents are registered with a GP and other healthcare professionals visit as required. There is equipment for moving and handling and pressure relief. residents have a nutritional assessment and are weighed monthly. The home has a pressure sore policy which requires some 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 requires further reviewing and updating and must state what the home actually does. The appendices referred to were not attached to the policy. Cowbridge Nursing Home DS0000009169.V273131.R01.S.doc Version 5.1 Page 13 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): EVIDENCE: These standards were not inspected on this occasion. Cowbridge Nursing Home DS0000009169.V273131.R01.S.doc Version 5.1 Page 14 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 and 18 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. Thank you cards and letters are kept. The complaints policy requires updating as it refers to a manager who is no longer employed by the Company 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 that is detailed in respect of the signs and symptoms of abuse. 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. It must also include reporting to the Commission for Social Care Inspection. POVA training has been taking place, ten staff have attended. Cowbridge Nursing Home DS0000009169.V273131.R01.S.doc Version 5.1 Page 15 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 and 26 The home and grounds are well maintained; there are areas being addressed to ensure a safer environment for residents, staff and visitors. The home is clean but the strong smell of disinfectant is unpleasant. EVIDENCE: The inspectors did not tour the whole building but the areas seen were clean. There is a strong smell of disinfectant in the home, which is unpleasant. One toilet downstairs requires an appropriate lock fitting and a supply of paper towels in the dispenser. The staff room has been improved work is still in progress and a door has to be fitted. It is noted that the greenhouse has now been removed and someone was clearing rubbish from the outbuildings into a skip during the inspection. Cowbridge Nursing Home DS0000009169.V273131.R01.S.doc Version 5.1 Page 16 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 and 30 Staffing levels meet the needs of residents and staff are happy in their roles. Residents are in safe hands and benefit from the number of care staff that have an NVQ qualification. The home is endeavouring to improve training for staff so they will be more competent in their roles. EVIDENCE: There are 31 staff employed at the home, 20 of these are care staff. The registered manager said that a RMN or competent RGN is on duty at all times. There are normally four care assistants on duty during the day and two at night. The registered manager said that care staff have either achieved or are studying towards an NVQ qualification in care. He said that 95 have achieved at least NVQ level 2. The training file was inspected and shows that staff training is being addressed. Infection control training has recently been undertaken by 12 staff, POVA training by 10, Health and Safety by 13 and moving and handling by 15. The registered manager said he has recently undertaken a course to be the home’s moving and handling trainer. Other training booked in the next three months is the promotion of continence, food hygiene, venepuncture, dementia, dysphagia and Parkinson’s disease. The home’s restraint policy refers to ‘minimum reasonable force’ but there is no mention of what this means and what training staff receive. The registered manager said that challenging behaviour and restraint training will be undertaken in house.
Cowbridge Nursing Home DS0000009169.V273131.R01.S.doc Version 5.1 Page 17 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): 35 and 37; There is a system in the home for dealing with residents’ money further safeguards must be put in place to fully protect the residents’ financial interests. The home has record keeping, policies and procedures in place that do not fully safeguard the resident’s rights and best interests. EVIDENCE: 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 communications book was inspected, on the whole it was used for out patient appointment dates and so on but it also contained information for several residents on the same page. If information has to be passed on to staff in this way it should be destroyed when communicated. It also contained information that was very personal to individual residents. Resident’s
Cowbridge Nursing Home DS0000009169.V273131.R01.S.doc Version 5.1 Page 18 information should be maintained in their individual records only. The home’s policies have been reviewed those inspected have improved but minor adjustments need to be made. Cowbridge Nursing Home DS0000009169.V273131.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 2 X 2 X Cowbridge Nursing Home DS0000009169.V273131.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP1 OP7 Regulation 6 15 Requirement The statement of purpose must be reviewed and updated Each resident must have a written care plan that includes all of their individual health, personal and social care needs, expected outcomes and how needs will be met. The interventions required and the specific action to be taken must be recorded to direct staff. The 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 risk assessments for individual residents must be
DS0000009169.V273131.R01.S.doc Timescale for action 07/08/06 07/08/06 3 OP7 15 07/08/06 4 OP7 13(4)(c ) 07/08/06 5 OP7 12 07/08/06 6 OP7 12 06/03/06 Cowbridge Nursing Home Version 5.1 Page 21 7 8 9 10 OP8 OP9 OP18 OP19 12(1) 13 12 13,23 11 12 13 14 OP21 OP19OP10 OP26 OP22 13
12(4)(a) 13(3) 13,23 15 16 OP26 OP29 16(k) 17 available to care staff at all times. 4th notification The pressure sore policy must be reviewed and updated Medicines policy must be further reviewed and updated. The home’s adult protection policy must be reviewed and updated. 3rd notification 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 The flooring in the en suite facility in room 23 must be impervious. 2nd notification Appropriate locks must be fitted to the toilet doors Paper hand towels must be available in the dispensers in the toilets All wheelchairs must be in correct working order and have foot rests attached to ensure safety when moving residents around the home. 3rd notification The home must be kept, as far as possible, free from offensive odours Recruitment records required by legislation must be maintained. 4th notification 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
DS0000009169.V273131.R01.S.doc 07/08/06 07/08/06 07/08/06 05/06/06 08/05/06 08/05/06 06/03/06 08/05/06 08/05/06 06/03/06 17 OP30 13 07/08/06 18 OP35 13(6) 07/08/06 Cowbridge Nursing Home Version 5.1 Page 22 19 OP38 23 20 21 OP37 OP37 17 17(1)(b) registered manager. There must be adequate 30/04/06 changing facilities for staff (a facility for catering staff) with lockable storage for personal belongings. 3rd notification All records required by legislation 08/05/06 must be kept in the home. 3rd notification Information about residents 06/03/06 must not be held collectively, if used for communication purposes it must be destroyed when conveyed 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 OP3 OP7 OP7 OP8 OP19 Good Practice Recommendations The initial assessment document should states who is involved in the assessment 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 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. Signed staff contracts, terms and conditions of employment and job descriptions should be held in the home. The complaints policy should be amended to make reference to expressions of concern can be made to CSCI
DS0000009169.V273131.R01.S.doc Version 5.1 Page 23 6 7 8 9 OP21 OP24 OP26 OP16 Cowbridge Nursing Home at any time. Cowbridge Nursing Home DS0000009169.V273131.R01.S.doc Version 5.1 Page 24 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
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