Inspection on 20/12/07 for Coxwell Hall and Mews Nursing Home

This inspection was carried out on 20th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Coxwell Hall and Mews Nursing... 03/03/09

Coxwell Hall and Mews Nursing... 08/01/07

Coxwell Hall and Mews Nursing... 23/05/06

Coxwell Hall and Mews Nursing... 27/02/06

Coxwell Hall and Mews Nursing... 16/05/05

Coxwell Hall and Mews Nursing... 08/02/05

Coxwell Hall and Mews Nursing... 30/06/04

Coxwell Hall and Mews Nursing... 19/02/04

Similar services:

21 High Street

Vale House

Chestnut Walk

Dunwood Manor Nursing Home

The Old Vicarage

Excelsior

Cherwood House Care Centre

Durban House Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Coxwell Hall and Mews Nursing Home Fernham Road Faringdon Oxfordshire SN7 7LB Lead Inspector Delia Styles Unannounced Inspection 10:30 20 December 2007 th 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 Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.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. Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Coxwell Hall and Mews Nursing Home Address Fernham Road Faringdon Oxfordshire SN7 7LB 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) 01367 242985 01367 241594 coxwellcare@yahoo.co.uk Sovereign (Coxwell Hall) Limited Post vacant Care Home 68 Category(ies) of Dementia - over 60 years of age (68), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 60 years of age (37) Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. On admission persons should be aged 60 years and over. That eight existing service users with OP needs remain in the home, Date of last inspection 8th January 2007 Brief Description of the Service: Coxwell Hall and Mews is registered to provide care for up to 68 people from the age of 60. The company voluntarily limits occupancy to 27 in Coxwell Hall and 36 in Coxwell Mews to reduce the number of double rooms to one on each unit. The home has two separate units, linked by a covered walkway. Coxwell Hall and Coxwell Mews specialises in the care of people with dementia. Registered nurses are on duty 24 hours a day to provide nursing care and to supervise care assistants. En-suite facilities of toilet and washbasin are provided in Coxwell Mews. Three bedrooms there have full en-suite facilities. In the Hall all rooms have en suite facilities of toilet/washbasins, except for one room on the first floor. There are communal lounges and dining rooms in each unit. Coxwell Hall is an early 19th century Grade 2 listed building, whilst the Mews was purpose-built. It is set in its own grounds on the outskirts of the market town of Faringdon in Oxfordshire. The Hall has a pleasant private patio and the Mews also has its own private secure garden. Both are equipped with attractive garden furniture. Fees range from £624 to £900 per person per week. Extras include hairdressing, chiropody, newspapers and toiletries. Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection of the service was an unannounced ‘Key Inspection’ during which the inspector assessed a number of the standards considered most important (‘key’) by the Commission out of the 38 standards set by the government for care homes for older people. The inspection visit started at 10:30 am and lasted for approximately 5½ hours and was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s managers in the form of their Annual Quality Assurance Assessment (AQAA) and any information that we have received about Coxwell Hall & Mews since the last inspection. The AQAA is a self-assessment of how well the home feels they are meeting the standards of care for people living at the home. All registered homes and agencies must send us their AQAA each year. During the inspection all areas of the home were visited and a sample of records and documents relating to the care of the people living here were looked at. A number of residents and staff and visitors shared their views about the home during the day. A telephone interview with one GP and a health care professional who visit the home were undertaken. We would like to thank the residents, managers and staff for their welcome and assistance during the inspection process especially during the visit to the home that took place during a time when staff were busy with Christmas preparations. What the service does well: Residents and their families find that the home is welcoming and friendly. Visitors commented that they are always made to feel welcome and ‘at home’ when they visit. The staff team has stayed largely the same in past months so that the people who live here have the reassurance and familiarity of being cared for by staff whom they know and who understand their individual care needs. There is good communication between the staff and the visiting medical and health and social care workers, so that the health needs of people living here are met. Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.S.doc Version 5.2 Page 6 The ongoing work to upgrade and redecorate the home continues to improve the appearance and comfort of the living space for residents. The acting manager does regular checks of the standard of the cleanliness and safety in the home to make sure that people have pleasant and safe surroundings to live in. What has improved since the last inspection? What they could do better: The care records should be improved to give more information about whether the planned care has met people’s care needs and if not, what changes have been made to their care or treatment. The written care plans largely describe people’s physical care needs, but because most people living in this home have problems with their memory, the care plans should also show more detail about how staff plan to meet people’s emotional and social care needs and assess their well-being, when they may not be able to say how they feel. The home has identified several areas it plans to improve in – * Formal staff supervision - making sure that all staff have a regular opportunity at the recommended frequency of at least every 2 months to meet with a senior member of the care team to discuss their work and any training needs they may have * Look at how the recent changes in the law – the Mental Capacity Act – affects the care of people living here and make changes to some of its paperwork and guidance as a result * Develop ways in which the people who live and work here can share their opinions about the service and ways it could be improved with the homes owners, for example through questionnaires or discussions. As the home already knows these are areas for improvement these are not listed as recommendations in this report Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.S.doc Version 5.2 Page 7 Though it is good for people living here to have a staff team whom they know, and agency staff are not used, there is a potential for the permanent staff to work a lot of extra hours to cover for others’ absence. From looking at the staff duty rotas, and talking to staff working in the home, it was considered that though there are generally enough staff to look after the physical needs of people, staff do not have enough time for social and recreational care that is an important part of peoples’ well-being. The home must review the number of staff employed to make sure that all aspects of care of the residents are met and to allow for staff training and cover for sickness and holidays. 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. Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.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 Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.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 and 3. Standard 3 does not apply, as the home does not provide intermediate care. Quality in this outcome area is good. The written information about the home and the pre-admission procedures provide prospective residents and their representatives with sufficient information for them to be clear about the services the home provides so that they can make informed decisions about admission to the home. Prospective residents are fully assessed before they come to live here so that they can be confident that the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has reviewed and updated its information - the Statement of Purpose and Service Users Guide - in August 2007. A copy of a contract and terms and conditions of residence, plus an additional leaflet describing the Residents Charter of Rights and the home Philosophy of Care are also given to all prospective residents and their families. The acting manager explained that a new improved colour brochure of the home is to be produced soon. Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.S.doc Version 5.2 Page 10 Relatives spoken to confirmed that their experience of arranging admission for their family member had been good – the acting manager and senior staff had been helpful and understanding. They had visited the home prior to their relative being admitted, and had read our last report about the home. The homes own assessment of their admission procedure states that they intend to review the admission policy and amend it if necessary in line with the new Mental Capacity Act legislation. It is also intended that a summary of the results of the homes most recent Quality Assurance questionnaire will be included in the Service Users Guide so that the views of the people who currently live here are shared with prospective residents. Further amendments are needed to show the change in management arrangements. From the sample of the care records for four recently admitted residents, it was seen that all had been assessed by the manager or another senior member of staff prior to their admission, and that information about peoples’ care needs had also come from their relatives and other health and social care professionals. Where possible (and if the person moving into the home is unable to do so for themselves) family members are asked to complete a ‘life history form’ which describe their relative’s interests and hobbies and family and friendships; this is very helpful to staff in getting to know people and help them settle in and feel ‘at home’. Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.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 good. Further improvements to the care planning system have been made since the last inspection and overall the written records of care provide staff with the information they need to satisfactorily meet residents’ needs. The systems for the administration of medicines have also improved with good liaison with the supplying pharmacist to ensure residents’ medication needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From the sample of care records examined, talking to the residents about their care (if they were able to give their opinion) and the relatives of 3 residents who were visiting, we found that the care plans adequately described the care needs of the residents and what care staff should do to assist residents in the best way. The care plans tended to describe the physical care of residents in more detail than their emotional and mental health needs. As most residents have shortterm memory problems because of their dementia, staff should consider how to develop the care records to show how they assess and plan care that helps Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.S.doc Version 5.2 Page 12 people to be involved in the day-to-day life of the home and that give them pleasure and enjoyment. The care plans all had an assessment of needs and risk assessments covering moving and handling, nutrition and falls. For one person who had recently been admitted and assessed as ‘not at risk’, it was later noted was underweight and had been prescribed a food supplement. There was no specific care plan to describe what actions staff needed to take to make sure that this individual’s dietary intake improved to reduce their risk of malnutrition. All the care plans showed that peoples’ care is regularly reviewed by the nursing staff, and record visits by the GP and other health and social care workers involved in their care. The care plans could be further improved if staff wrote some evaluation comments when they review the plans or when changes to care are needed; this would show to what extent the planned care had met the resident’s assessed needs or preferences. Evaluation should involve asking the residents and their families their opinions. Two GPs spoken with (one at the home and one during a telephone interview) said they were happy with the care provided and that communication between the home and GPs had improved over recent years. Because there had been fewer staff changes, the GPs now know the nurses and feel confident that any changes in the residents’ condition is identified and reported to them. A GP from the two Medical practices that provide medical care in the home, visit routinely every week. The manager said that they have good support from a consultant psychiatrist and local community mental health nursing team who will visit and advise on the care of residents with particular problems such as behaviours that others find challenging. This was evidenced in one of the care plans seen, with a monthly assessment of a resident’s needs involving a community psychiatric nurse. The Medication Administration Records (MAR) charts for the four residents ‘case-tracked’ were looked at. These were correctly completed and up to date, showing that people had been given their prescribed medicines correctly. A local chemist supplies the medicines prescribed. The local pharmacist had visited and a medication report was available for November 2007 and shows that the recommendation made at our last inspection has been followed up. The systems for the storage, administration and disposal of unwanted medicines are good, and are audited by the home to make sure that the medication needs of the residents are safely met. Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.S.doc Version 5.2 Page 13 During the inspection we observed staff working patiently and kindly with residents with dementia and treating them with care, dignity and respect. Relatives spoken with said that the staff were very good and were always willing to be adaptable to give them privacy – for example, making sure that someone could have their lunch later, or in the sitting room, if their visitors were there at mealtimes. The home’s philosophy of care and statement of purpose are specific about the aims of the home in protecting peoples’ privacy and dignity, and supporting people to have the choice about the pattern of their day – for example, when they like to get up or go to bed, and staying in their own rooms or joining others for meals or group activities. A GP spoken with said that s/he was always able to see their patients in private, and that staff were respectful and mindful of people’s dignity when assisting the GP with medical examinations or treatment. Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.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. A range of activities is offered that provide opportunity for mental and physical stimulation for people, though this should be improved for more dependent residents. The people who live here are encouraged to maintain contact with their family and friends and are able to have visitors at any time. The home provides a varied and nutritious menu designed to meet the individual needs and preferences of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One of two activities coordinators has left since the last inspection. Currently there is one designated activities worker and two staff whose main role is laundry and domestic work in the home, but who also have some hours to organize activities. The manager said that this allows for some planned activity to take place in each part of the home every day. The homes AQAA states that they are hoping to ‘recruit and appoint two more activity staff to provide a greater range of activities over the whole week, and to develop a designated activities room in the Mews to provide a quiet but stimulating environment for all residents and their visitors’. Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.S.doc Version 5.2 Page 15 A calendar of planned activities was on display on the notice boards in each unit. Each person’s care record contained a ‘life history’ and description of their interests, hobbies and ‘support network’. The activities workers write a brief description of any activity the individual have been involved with during the day. Recently admitted residents are the priority for individual attention, so that they can be encouraged to talk about their interests and staff can get to know the type of hobbies and activity that they might enjoy. This was evidently working well. However, there was no individual written plan of care for the recreational and social aspects of daily life for each resident, so it was difficult to assess to what extent people were able to engage in the type of activities that interested them, or how staff were planning to help them maintain and develop new skills and interests. The hairdresser was busy in the ground floor lounge in the Mews building. The manager explained that there are plans to divide this lounge in two and to create a sensory room for residents to enjoy. A visiting ‘sensory’ bus service has proved very successful with some residents, and it will be good for the home to develop their own permanent sensory/quiet room centre. The first floor sitting room in the Mews is less spacious and several residents were noted to be restless and calling out repetitively. During the afternoon, staff were busy with physical care of other residents, serving tea and providing ‘one-to-one’ care for a person who needs a quiet environment. Staff said that planned group activities are limited for this client group and that it was stressful trying to divert and distract residents with repetitive and ‘challenging’ behavior with the current staffing numbers. The chef works closely with the manager to discuss and plan the menus. The home AQAA (completed in August 2007) states that they have recently introduced new menus that are ‘research-based, nutritionally well balanced and offer greater choice’. Menus are displayed on the small dining room tables and are laminated with pictures of the food choices, to help residents recognise and make their choices. On the day of inspection Shepherd’s pie or pot roast chicken, served with sauté potatoes, green beans, and carrots were the choices for the main course, with Banoffee pie and ice cream, or jelly, yogurt, ice cream or fresh fruit for dessert at lunchtime. Foods are prepared to suit differing needs, such as pureed for those with swallowing difficulties, and are presented appropriately. Several residents spoken to say the food is very good that they had enjoyed their lunch. A relative commented that the meals were ‘like a 4 star hotel – people always have a choice and even if they change their mind when the meal is served, they are always offered an alternative’. Meal times are flexible so that if a resident likes to get up late and have breakfast (or cooked breakfast) then lunch and supper are offered at later Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.S.doc Version 5.2 Page 16 times so that they are ready to eat again later in the day and can maintain a balanced diet. Snacks and drinks are available through the night. Family, friends and relatives are welcome to join residents for meals free of charge. In common with many residential and NHS care environments, there is more ethnic and racial diversity represented in the staff team than amongst the current residents, 99 of whom are white, British and Christian. The homes policies philosophy of care sets out the aim to ‘enable residents to feel socially valued by recognising their individual abilities, preferences and needs’. Staff have training that focuses on ‘person-centred’ care and supporting people to make choices about their lives as far as possible. Overseas staff whose first language is not English are encouraged to improve their spoken English and a literacy course has been arranged to help staff with written and verbal skills. From direct observation and the comments received, we consider that this home would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. The home has a satisfactory complaints system and residents and their representatives’ views are listened to and acted upon. Staff have a good understanding of safeguarding issues and the homes policies and procedures that protect residents from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complaints log is kept. The acting manager said she had received one complaint since she has been in post; this was to do with food – seasoning and presentation - in relation to one resident and was partially substantiated and satisfactorily resolved within the required timescale. The Commission has received information concerning one complaint made against the service since the last inspection: we consider that the provider has met the regulations in relation to complaints, and the complainant is satisfied with the outcome. The outcome of a safeguarding adults investigation and a referral to the Protection of Vulnerable Adults list made in April 2007 is still awaited. The homes records showed that all staff attend training in safeguarding adults and are given copies of the local Oxfordshire social services guidance about how to recognise and report suspected abuse. The acting manager confirmed that she has attended more extensive training in adult safeguarding. Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.S.doc Version 5.2 Page 18 Staff also have training in the principles of dementia care that includes how to manage residents’ behaviour that may challenge them, and how to reduce the risk of residents’ acting aggressively because they are confused so that any physical restraint or intervention is avoided. The acting manager, and family support/administrator are readily available to residents and their relatives, visitors and friends on a daily basis. It was evident that people felt that the manager and staff were approachable and they could talk to them about any concerns or issues affecting their care and support. Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. Overall, the standard of the environment is good providing the people who live here with a clean, comfortable and homely place in which to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The programme of redecoration and refurbishment of the home is continuing with the result that the home is commendably clean and the standard of the decoration very good. The new décor has made the environment lighter, and the furnishing is comfortable and attractive. New dining room furniture has recently been provided in the Mews. The home has a full time maintenance worker who manages the day-to-day maintenance and repairs in the home and keeps maintenance records up to date. Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.S.doc Version 5.2 Page 20 The acting manager undertakes a weekly check of the cleaning schedules and buildings to make sure that the standards are kept up. Visitors spoken with were satisfied with the standard of cleanliness and decoration of their relatives’ rooms and the communal areas. The homeowners are looking at ways to improve the conservatory rooms, especially in the Hall, so that they can be used all year round. At the moment the conservatory is too cold. Relatives we spoke to said it was a pity that it could not be used in the winter months, as it is a good spacious area in which to spend private time with their family member when they visit. The laundry room in the Mews is small for the amount of laundry work undertaken for the whole home. However there appear to be satisfactory arrangements for the separation of heavily soiled laundry work and protective clothing for laundry staff. Separate additional rooms are used for ironing, storage of clean linen and sorting of clean personal clothing ready to take back to residents’ rooms. We noticed a strong and unpleasant odour of drains in one sluice room on the first floor of the Hall indicating that the drainage and/or cleaning of the open sluice hopper sink area could be inadequate. The acting manager asked cleaning staff to attend to this promptly. Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. There are usually enough staff to meet residents’ physical needs, but staffing numbers and skill mix are not always sufficient to allow the time needed for the emotional and recreational care of people. The arrangements for the recruitment and vetting of staff are satisfactory so that residents are protected from people who are unsuitable to work in the home. Staff training and supervision programmes are in place with all staff demonstrating an awareness of their roles and responsibilities towards residents’ care and wellbeing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staffing rota showed that the home plans for staffing levels for the whole home of 3 registered nurses (RNs) and 8 care staff during the day (08:00 to 20:00); and 2 registered nurses and 5 care staff overnight (20:00 to 08:00). This means that the Hall has one RN and 4 care staff and the Mews have one RN and 2 care assistants for each floor. The acting manager (a registered nurse) is also available. The family support worker/administrator, domestic, catering, maintenance and laundry staff were also on duty. The home does not use agency staff, so permanent staff cover any vacant shifts for colleagues who are off sick, on holiday or attending study/training sessions. Because staff work mainly 12 hour shifts, cover for absences involves permanent staff ‘picking up’ additional long hours: for example on the day of the inspection two care staff were off sick so that others had to fill 24 Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.S.doc Version 5.2 Page 22 hours work. Most staff work a basic 48-hour week so that picking up additional hours may mean they work considerably more than this with reduced time off between shifts. Whilst it is good that residents have good continuity of care from staff who know their individual care needs well, there is a potential for staff to become overtired which increases the risk that this will have a negative effect on their own health and therefore the standard of their care for residents. One staff member said that in his/her experience, staff were often ‘too tired’ to cover additional shifts when requested and declined to do so. Three staff members spoken with indicated that although the home was not fully occupied, the workload was still demanding and at times very stressful and that the number of staff available, given the layout of the building and complex needs of residents, was not sufficient to meet the residents’ needs, particularly in relation to spending time to talk and be involved in activities with them (see also ‘Daily life and Social Activities’ above). One individual said that they have raised the matter of staffing numbers with the acting manager and requested more staff. The acting manager said that she monitors the rotas to make sure that staff are not overworking and to ensure that staff requests for specific days off are met as far as possible. Staff recruitment has been successful and vacant posts should be filled in the near future. The sample of staff files looked at showed that all the appropriate checks and references had been received before permitting new staff to work in the home, showing that people who live here are protected from having unsuitable staff caring for them. On the day of the inspection it was not easy to find the information needed – for example when references had been requested, when received and whether they were satisfactory. A simple checklist of the required information and contents of the files would improve the record-keeping system and would provide an easy reference ‘audit trail’ of required information. Staff agreed this would be implemented as part of the review and updating of files that was currently underway. A health professional said that s/he felt that there had been improved communication and rapport with staff in the home because there is an established staff team, most of who have worked there for over a year. Also, because staff ‘rotate’ to work in different parts of the home, they know all the residents well and can accurately report and comment on their care and any changes. The same person commented that staff ‘seem happy and content’ in their work. The two other health care professionals spoken to as part of the inspection process were also positive in their comments about staff and the standards of care provided. Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.S.doc Version 5.2 Page 23 The home has a training programme and the group-training manager from the organisation provides training on a regular basis. The homes AQAA (completed in August 2007) shows that eight of the total of 27 care staff at that time had achieved a National Vocational Qualification (NVQ) in care at Level 2 or above and further 10 were working towards achieving NVQ Level 2 or above. This shows that the home has a rolling programme of training in place and should achieve the recommended percentage (50 ) of NVQ qualified care staff in the next 12 months. The home has also continued to improve the standard of training for staff in relation to the care of people living with dementia, so that all care staff have attended sessions in the Principles of Person Centred Dementia Care, Managing Behaviour that Challenges Us, and Breakaway training. Three RNs confirmed that they had attended dementia care training and relevant training such as wound care. They said that the organisation provides good opportunities for training and development. One GP said that in their opinion better staff training in dementia care had resulted in better care of residents because staff were now more skilled at identifying agitation and in preventing behavioural problems such as aggression than had been the case formerly. Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. The temporary management arrangements are meeting the needs of the home and the quality of the service and care for the people who live here is improving. The home regularly reviews its performance through audit checks and questionnaires administered to relatives and representatives of residents to get their views. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager left the home in May 2007. The home currently has an acting manager in post who is very experienced in care of older people and has worked at the home for many years. She said that she is working for a 6month trial period as manager with a view to applying to become the registered manager in the future. She is currently undertaking the Registered Managers Award course as part of her preparation and development for the job. She is planning to undertake a further course in dementia care training in Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.S.doc Version 5.2 Page 25 January 2008. There is no deputy manager currently. The person registered with the Commission to represent the homes owners visits weekly and is readily available for support and advice the acting manager said. Senior managers for the organisation also visit the home as required by law (Regulation 26 Care Homes Regulations 2001 and Care Standards Act 2000) to check that the care and facilities are meeting residents’ needs and to provide a report to the manager as a result of their visit. The home has introduced an audit system that involves the manager physically checking the home at least weekly to make sure that the standards of cleanliness and infection control are being maintained throughout the home. The home holds quarterly Relatives’ meetings and circulates ‘news and views’ in the form of a newsletter for the home. A questionnaire is sent out to all relatives once a year to invite their views about the service and facilities provided. There are plans to improve the way in which the home gets feedback about the home by developing a Residents Satisfaction Survey and a staff Quality Assurance Questionnaire. It is recommended that this should be extended to inviting the views of other NHS and local authority health and social care professionals involved in supporting the people who live here. The procedures for the management of residents’ finances were discussed with the manager and administrator. The records seen showed that monies received and spent on behalf of residents are recorded appropriately. Resident’s finances and possessions are safeguarded by the efficiency of the home’s administrator. Only small amounts of cash are held in the home – a non-interest bearing bank account is used for depositing residents’ individual personal allowances; the balances for each individual resident can be identified and checked. In the laundry we noted that there was an uncovered water/boiler tank and associated pipe and electrical wiring next to the hand-washing sink; the home should ensure that this arrangement does not increase the risk of fire or accidents for people working in the laundry. The acting manager confirmed that all the required health and safety checks and those required for the home’s equipment are carried out on time and at the required frequencies. The training opportunities for staff include subjects relating to health and safety and staff members spoken to, confirmed that their knowledge is updated periodically. The acting manager also confirmed that all the recommended policies and procedures are available on each unit of the home and that these have been reviewed and re-written in the last 12 months. Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP27 Regulation 18 (1)(a) Requirement Review and adjust the numbers of staff accordingly to ensure that there are always sufficient suitably qualified, competent and experience workers to meet the health and welfare needs of the service users Timescale for action 29/02/08 Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP7 Good Practice Recommendations Update the Statement of Purpose and Service Users Guide to accurately reflect the management arrangements for the home. Develop care plans for the social and psychological care of residents and ways of assessing, evaluating and recording residents’ overall ‘well-being’ Provide written evaluation of the care delivered and amend the care plans as necessary. 3. OP33 Implement the planned development of the quality assurance monitoring (residents and staff surveys) and extend this to include the views of other health and social care professionals who provide services for people living in the home. Review the layout and safety of machines and equipment in the laundry to ensure the safety of workers is not compromised. 4. OP38 Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Coxwell Hall and Mews Nursing Home DS0000027145.V348742.R02.S.doc Version 5.2 Page 30 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!