Inspection on 23/05/06 for Coxwell Hall and Mews Nursing Home

This inspection was carried out on 23rd May 2006.

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

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

Other inspections for this house

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

Coxwell Hall and Mews Nursing... 20/12/07

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

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

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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 Lilian Mackay Unannounced Inspection 23rd May 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Coxwell Hall and Mews Nursing Home DS0000027145.V295636.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. Coxwell Hall and Mews Nursing Home DS0000027145.V295636.R01.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 Mrs Carol Burnett Care Home 68 Category(ies) of Dementia - over 65 years of age (37), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (37), Old age, not falling within any other category (31) Coxwell Hall and Mews Nursing Home DS0000027145.V295636.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Condition 1. On admission persons should be aged 60 years and over. Condition 2. The total number of persons that may be accommodated at any one time must not exceed 68, of which 37 may be in either the DE(E) or MD(E) category. 27th February 2006 Date of last inspection 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 provides care for people with general care needs and Coxwell Mews specialises in 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 in addition to two baths and two showers. 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, and there are two baths and two showers. 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. At this time fees ranged from £589 to £850 per person per week Coxwell Hall and Mews Nursing Home DS0000027145.V295636.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an announced ‘Key Inspection’. Two inspectors, Lilian Mackay and Nancy Gates, arrived at the service at 10.00am and were in the service for seven and a half hours and another inspector, Kate Harrison, arrived at 12.30pm and was in the service for five hours. The inspection took into account detailed information provided by the service’s registered manager, and any information that the CSCI has received about the service since the last inspection. The residents living in this home are all aged over 65. The inspectors looked at how well the service was meeting these standards set by the government and have in this report made judgements about the standard of the service. The home has breached its conditions of registration as the manager reported on 12/05/06 that there were 48 residents with a dementia and 45 with mental health needs. Condition 2 of the conditions of registration are that the total number of persons that may be accommodated at any one time must not exceed 68, of which 37 may be in either the DE(E) or MD(E) category. The Commission is considering what action it will take in relation to this. It has since been confirmed that 39 residents have been admitted under the DE category and 6 under the MH category. To further inform the findings of the inspection the inspectors asked residents, staff, relatives and social and healthcare professionals associated with the care home their views and opinions of the service provided. 100 of those residents who responded to surveys indicated that they received enough information before moving into the home, that they usually receive the care and support they need, that staff usually listen and act on what they say, that staff are usually available when needed, that they usually receive the medical support they need, that they usually like the meals at the home, that they always know who to speak to if they are not happy, that they usually know how to make a complaint and that the home is usually fresh and clean. Their comments included, “Occasionally there is a urine smell but it has improved greatly in the last two years”, “The staff on the EMI unit (Mews) are very kind and patient. It would be nice if they could employ English (speaking) staff. I have a problem occasionally in understanding them”, “I find sometimes that the EMI unit (Mews) is understaffed and, on occasions, no staff sat with residents in the lounge where most residents sit most of the day”, “There has been a lack of activities in the last few months. However, I think there is now an activity helper”, “The EMI unit (Mews) is smelly and curtains need cleaning or replacing. X’s room smells of urine and we take air fresheners and plug-ins to mask the smell. However, the cleaning staff are doing their best”. Coxwell Hall and Mews Nursing Home DS0000027145.V295636.R01.S.doc Version 5.2 Page 6 100 of social and healthcare workers who responded to surveys indicated that staff demonstrate a clear understanding of the needs of their clients, that there is a care plan in place for clients they have placed at the home, that they are able to meet with their clients in private, that there is always a senior member of staff available to speak with and that the home’s inspection report is made available to them on request. 100 indicated that the home does not always notify them of significant events affecting their clients’ well-being. Their comments included –“It’s not a home of choice it’s a last resort.” “The command of English of some members of staff is very poor.” “Recently a client was moved and we were not told about it until the review.” “They liaised with me the first two weeks X was there.” “I couldn’t fault the way they [staff] treated X in the first two weeks. “No problems. Everything is going well”. “At X’s review the family could not praise the home enough.” “She [a resident] looked a different lady. Her nails were painted, her hair was done, she was ready to laugh at things.” 100 of GPs who responded to surveys confirmed that they are able to see their patients in private. 66 are satisfied with the overall care provided to residents. 33 confirmed that copies of the CSCI inspection report are made available to them on request. Their comments included, “In the last year there have been medication errors. Staff are always pleasant and try to be helpful. (They) usually alert me early when there is a problem though transfer of information/handover is not always happening”. “Poor linguistic skills of staff. Inadequate communication with residents”. 100 of relatives who responded to surveys indicated that they are made welcome in the home at any time, that they can visit their relative or friend in private, that they are kept informed of important matters affecting their relative/friend, that they are consulted if their relative/friend is unable to make decisions about their care. 33 were aware of the complaints procedure. 66 feel there are sufficient staff on duty. 66 were satisfied with the overall care provided by the home. Comments included, “ The bus service is not good from Wantage.” “Sometimes I’ve gone there and I’ve been dismayed at the state of him. The last time I went in he looked good.” “We don’t think the cleaning standards are high. Also it seems to have a lack of English-speaking personnel. Although they are hard to understand, they are very nice”. “They do the best they can.” “X’s clothes are not always ironed and everything seems to be creased.” “Very few of the staff speak good English.” “It’s very difficult when you ‘phone in the evening to speak to the person in charge on the Mews. “Overall we are quite happy.” “There’s one member of staff who is excellent with him.” “I am delighted with the standard of care which X receives”. “Their nursing care and kindness is wonderful. My mother and I could not wish for him to be in a better place”. The inspectors would like to thank the residents, the area manager, the manager, the staff and all those who responded to questionnaires for their assistance, hospitality and courtesy during this inspection. What the service does well: Coxwell Hall and Mews Nursing Home DS0000027145.V295636.R01.S.doc Version 5.2 Page 7 Risk assessments are carried out of each room prior to a new resident’s admission. A nutritional assessment is compiled for all those admitted. Health care interventions are requested appropriately. Staff are helpful and cooperative. Discussion with an activities co-ordinator highlighted a range of activities showing an attempt to recognise resident’s preferences and interests. Residents and family members spoken with expressed positive views of the activities offered, “My mother is very happy here…there’s been such an improvement in her well-being since she been here…we’re very happy.” One resident stated that, “ I’m happy that I don’t have to join in if I don’t want to.” The Coxwell Hall and Coxwell Mews are comfortable, reasonably well decorated, providing lounge and dining areas for residents communal a private use as well as individualised bedrooms. Residents within Coxwell Hall expressed satisfaction at the standard of accommodation provided. Staff files are held within the home and contain the relevant recruitment information for the protection of residents Resident’s financial interests are safeguarded. What has improved since the last inspection? What they could do better: Identify in the Statement of Purpose the type of behaviour the home can or cannot cope with. Some areas of care given that are essential to meet service users’ needs need to be documented. It is recommended that those with a diagnosis of dementia receive an introductory visit from the CPN and regular visits thereafter. Behavioural Coxwell Hall and Mews Nursing Home DS0000027145.V295636.R01.S.doc Version 5.2 Page 8 management plans must be maintained for residents exhibiting extremely challenging behaviour. Restriction of liberty care plans should be reviewed at least six monthly, with the resident or their next of kin and a professional external to the home. Any alterations to medication records should be signed. Inform the Commission on each occasion when there is a serious injury to a resident and when any event adversely affecting the well-being or safety of a resident occurs. Improvements are required to ensure that principles of individuality and the dignity of residents is maintained. Overpowering odours present in Coxwell Mews must be addressed and not just masked by overpowering air fresheners. 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. Coxwell Hall and Mews Nursing Home DS0000027145.V295636.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Coxwell Hall and Mews Nursing Home DS0000027145.V295636.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Not all residents have their needs properly assessed before coming to live at the home. EVIDENCE: Although the Statement of Purpose has been amended since the last inspection to identify the type of behaviour the home can or cannot cope with it is recommended that further thought be given to this, particularly in respect of violent behaviour. Residents receive contracts outlining the Terms and Conditions. It is recommended that the home’s attitude to alcohol as outlined in the contract be reviewed to make it less dictatorial. One prospective resident was assessed without being seen by the senior staff member making the admission. This is poor practice. The care needs assessment of one resident admitted with a history of violent behaviour was Coxwell Hall and Mews Nursing Home DS0000027145.V295636.R01.S.doc Version 5.2 Page 11 incomplete in respect of temperament and inaccurate in terms of his cooperation with staff. The mental state section was not completed for two residents with challenging behaviour. Neither intermediate care nor respite care is provided. Coxwell Hall and Mews Nursing Home DS0000027145.V295636.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Additional recording is required in care plans to evidence that residents’ health care needs are fully met. Residents’ mental health and emotional needs are not fully met. Additional measures are needed to ensure residents’ right to privacy is respected. EVIDENCE: The inspector tracked the care of residents to see how health care needs are met. Records seen show that residents see a GP when the need arises, and are referred as necessary to other health care professionals in the community setting or at a hospital. Individuals are supported to maintain their personal care, and help is given when needed. Outcomes of risk assessments are acted on, for instance regarding pressure wounds or moving and handling residents. Where appropriate, equipment is provided. Coxwell Hall and Mews Nursing Home DS0000027145.V295636.R01.S.doc Version 5.2 Page 13 New residents with dementia are not automatically referred to the community psychiatric nurse. This is only done when a problem is identified. The care plans seen included appropriate risk assessments and detailed instructions for staff to enable them to carry out the care needed by the individual. Whilst care plans are reviewed monthly these tend to focus on the physical to the detriment of the resident’s intellectual, emotional, social and behavioural needs. The areas of the care plan are generic to all residents with very little evidence of a person-centred approach to care. Reviews are undertaken regularly. These should identify goals for the future. Review checklists should be signed and dated. Assessments are made and records kept of the mobility status of all new admissions and manual handling assessments are completed. Care plans are generally clear and accurate and good use is made of wound assessment charts, photographs and body charts. However, where toileting is necessary staff need to ensure that the frequency is recorded in the care plan and that a toileting chart is maintained and completed by staff on each occasion. Also, all personal and mouth care given should be documented in the care plan. When a critical incident occurs an analysis is undertaken of this. Those care plans seen did not clearly identify a strategy for preventing a recurrence of the incident. The inspector did not see a behavioural management plan for one resident exhibiting extremely challenging behaviour. It is recommended that those with a diagnosis of dementia receive an introductory visit from the CPN and regular visits thereafter. Evidence was seen that health care interventions are requested appropriately. The home has policies regarding the management of medication in the home, but only the Nursing and Midwifery Council guidelines were available for staff where the medication was stored. Other policies were in the office, and staff were not aware, for instance, that the Royal Pharmaceutical Society’s ‘The Administration of Medicines in Care Homes’ applied to the home. The inspector saw medication records and was satisfied that there is a system in place to meet regulation, but noted that one month’s supply of part of one individual’s medication was not recorded as received into the home. There is a system in place to dispose of unnecessary medication. However, controlled medication from one resident who had left the home more than seven days previously was still stored in the controlled drugs cupboard, as staff are not clear how unnecessary controlled drugs should be managed while awaiting disposal. Any alterations made to the medication records should be signed. Since the last inspection residents’ files are kept separately for privacy. Coxwell Hall and Mews Nursing Home DS0000027145.V295636.R01.S.doc Version 5.2 Page 14 The laundry area in the Mews whilst organised and tidy contained a basket of socks and a large amount of tights, stockings or pop socks hung on a clothes hanger. A member of staff stated that these items are shared by residents, items are not individualised. This clearly does not uphold the principles of individuality and does not maintain the dignity of residents. One resident said that the staff were ‘kind’, and another said that the staff were ‘good’. The inspector observed one nurse deal patiently and kindly with one resident with dementia, and observed other instances where staff were able to manage residents with care and respect. One member of staff said that dignity and respect issues were part of his/her induction training, and that respect for the residents was part of daily care. Two residents were in the conservatory when a training session for staff was about to start there. A member of staff said that the residents ”Didn’t mind” and that they could either stay or go elsewhere. An amendment to the home’s Statement of Purpose was made at this time to show that residents’ communal areas might be used for staff training sessions. Present residents and their relatives are not aware of this amendment and it is therefore recommended that consideration is given to how training can best be provided without compromising residents’ communal living space. Coxwell Hall and Mews Nursing Home DS0000027145.V295636.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 &15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Visiting arrangements are good. A range of activities is available for residents. Food and drinks arrangements are good. EVIDENCE: Activities co-ordinators are available in Coxwell Hall and Coxwell Mews, the Mews receiving a higher number of hours due to the higher level of resident need. Discussion with an activities co-ordinator highlighted a range of activities showing an attempt to recognise residents’ preferences and interests. The activities co-ordinator described the various activities, which included “balls, balloons, exercises, we gather around and have tea, there are social activities and we sometimes go outside”. An activities guide was posted at various points within the home written in a small letter height, no other formats were seen to be available. Coxwell Hall and Mews Nursing Home DS0000027145.V295636.R01.S.doc Version 5.2 Page 16 A small number of residents in Coxwell Hall were able to see the hairdresser and stated that they were happy with what the home has to offer. The co-ordinator stated that each person has an activities plan completed with the individual and with the involvement of family members and staff if possible. A number of residents were seen to have activities plans included within their care plans. The home’s policy regarding visitors is stated in the Statement of Purpose, and visitors are welcome. Several visitors were in the home during the inspection. Residents and family members spoken with expressed positive views of the activities offered, “My mother is very happy here…there’s been such an improvement in her well-being since she’s been here…we’re very happy.” One resident stated that, “I’m happy that I don’t have to join in if I don’t want to.” Action taken, which could be seen as a restriction of a service user’s liberty, is recorded in a restriction of liberty care plan. These should be reviewed at least six monthly, with the resident or their next of kin and a professional external to the home. The remaining strengths, skills and abilities of mentally frail residents are not identified on admission, making them susceptible to becoming over dependent. An excellent personal history was seen for one resident. This should inform the individual activity programme for this resident. Personal histories are not drawn up on all residents. These are essential if person-centred care is to be achieved. One resident was seen to receive a structured and individual activity programme. The food preferences of all those admitted are not always fully recorded. The daily records should evidence that these are respected. Whilst a nutritional assessment tool is compiled for all those admitted, these do not always indicate the outcome, making it impossible to assess if a nutritional care plan is required. The chef has been at the home for several years and speaks to residents about their food preferences regularly. Menus are displayed on the small dining room tables and on the day of inspection a choice between lamb and chicken was available at lunch. Foods are prepared to suit differing needs, such as pureed for those with swallowing difficulties, and are presented appropriately. Several residents said that the food was ‘good’. Residents are offered drinks at regular times during the day, and staff will prepare drinks at other times by request. Coxwell Hall and Mews Nursing Home DS0000027145.V295636.R01.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The complaints procedure meets the requirements of the Regulations and is prominently displayed. Senior staff need additional training to ensure they respond promptly and appropriately to allegations of abuse. EVIDENCE: The complaints procedure contains the contact details for the CSCI. A recent complaint highlighted a need for senior staff to have additional training in the protection of vulnerable adults from abuse. The manager is due to attend such training on 25/07/06. The home’s policy on the protection of vulnerable adults from abuse has recently been rewritten. The Commission has not always been informed as required on each occasion of a serious injury to a resident or of any event which adversely affects the well being or safety of any resident. Coxwell Hall and Mews Nursing Home DS0000027145.V295636.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home provides reasonably comfortable indoor and outdoor communal facilities. The home is reasonably clean but is unpleasant and unhygienic in areas. Residents’ safety is not maintained in all areas of the home. EVIDENCE: The Coxwell Hall and Coxwell Mews are comfortable, reasonably well decorated, providing lounge and dining areas for residents’ communal and private use as well as individualised bedrooms. Residents in Coxwell Hall expressed satisfaction at the standard of accommodation provided. Upon entering the home from the reception area in The Mews an overpowering odour of urine could be detected at various times during the inspection. In an Coxwell Hall and Mews Nursing Home DS0000027145.V295636.R01.S.doc Version 5.2 Page 19 attempt to mask the odour the home has installed intermittent air freshener devises, which spurt overpowering fragrance periodically. At various points within the time spent at the home staff were observed to be spraying air fresher around the Mews, again allowing for an overpowering mix of odours to be present. A staff member stated that this is due to residents’ removing continence pads, therefore “accidents” can happen and the carpets and furniture become wet and retain the odour. Staff added that the carpets and furniture are cleaned regularly but the odour remains. A staff member had limited knowledge of behavioural support and continence care of residents within the Mews, demonstrating a limited knowledge of how this impacts on the dignity of individuals. No offensive odours were present within Coxwell Hall. The first floor of The Mews again had a strong odour of urine although this was not masked by an overpowering smell of air freshener. A fire exit situated next to the laundry room on the ground floor in The Mews was left open during the inspection visit. The exit is adjacent to a staircase that leads to the first floor of The Mews and would allow access into the home from the rear garden without staff members being aware. This presents a clear risk to residents on the first floor and must be addressed. A dining area within the first floor of the Mews was dirty in appearance and contained dining chairs that were stained. An overpowering smell of urine was present within the room. A resident was sat on a stained and wet chair. A staff member stated that the chair had become wet at breakfast from the spillage of orange juice and hadn’t been cleaned or removed from the room. This again points to a lack of respect and a lack of acknowledgement in maintaining residents’ dignity. The external appearance of the home and the gardens was both pleasant and scruffy in areas. Hidden from view areas contained an old wheelchair, items of clothing, a pair of slippers and were clearly neglected. The cleanliness of the home was adequate in most areas, although radiator covers in most areas viewed were dirty. Coxwell Hall and Mews Nursing Home DS0000027145.V295636.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff training is poor. Recruitment procedures ensure the protection of residents. EVIDENCE: The staffing agreement between the Commission and Sovereign Management dated 24 December 2002 shows the minimum numbers of staff expected to be on duty when between 58 and 62 residents are in the home. On the day of inspection 56 residents were at the home, and the staffing rota shows that at least one registered nurse was on duty on each wing during every shift. Ten carers were available during the morning, and eight were available during the afternoon and evening. Of the 29 care staff at the home only 8 have training to NVQ Level 2 or an equivalent standard. This means that approximately 28 of the care staff are appropriately qualified, instead of the minimum 50 by 2005. Although an NVQ assessor may soon be available at the home, the home needs to improve the rate at which care staff acquire their NVQ qualifications. Staff files are held within the home and contain the relevant recruitment information for the protection of residents and are managed and maintained well by the home’s administrator. Staff records are held securely. Coxwell Hall and Mews Nursing Home DS0000027145.V295636.R01.S.doc Version 5.2 Page 21 Staff receive basic dementia training entitled “Yesterday, Today, Tomorrow”. Staff require additional training in responding to dementia-related behaviour such as shouting and screaming, incontinence, wandering and aggression. The home’s induction programme needs to be improved to meet the Skills for Care expectations, and should include assessment of competency and be completed by 12 weeks. After induction care staff should progress on to NVQ Level 2 training, but few presently do this at the home. The reasons for this not being addressed promptly are varied, but include the quality of English language skills of overseas staff as well as the lack of NVQ assessors. The home has a training programme and the group training manager from the organisation provides training on a regular basis. The home is registered to care for 37 residents over the age of 60 with either dementia or mental health difficulties, but appropriate training has not been provided for staff. Although basic training has been provided on dementia, it is not sufficient for staff to appropriately meet the residents’ needs, and no training on mental health difficulties has been provided over the past six months or more. Coxwell Hall and Mews Nursing Home DS0000027145.V295636.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 & 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Inadequate leadership, guidance and direction are given to staff to ensure residents with a mental disorder or dementia receive adequate care. The home is poor at promoting and protecting residents’ health and safety. Regular reviews of the quality are conducted. Resident’s financial interests are safeguarded. Coxwell Hall and Mews Nursing Home DS0000027145.V295636.R01.S.doc Version 5.2 Page 23 EVIDENCE: The manager is registered with the CSCI and is accountable for the service along with the responsible individual of Sovereign [Coxwell Hall] Ltd. She is not qualified to care for those with a dementia or a mental disorder but has had some experience of this. The home is now confirming in writing, prior to the resident’s admission, that they can or cannot meet the prospective resident’s health and welfare needs. On one occasion a resident was stopped from hitting staff. The manager must send the CSCI a copy of the home’s policy on restraint for information. Evidence was seen that the home is failing to protect residents’ safety from violent residents with a dementia or mental disorder. The accident book could not be found at this time and it was evident that the CSCI have not always been notified of such occurrences. Monthly visits by the training co-ordinator are made to the home to assess the quality of the service offered to residents. Assessment of the quality of care plans; medication administration records, recruitment and staff records are regarding as main themes for the visits with additional areas added within each visit. Copies of the reports made are sent to the inspector regularly. Visitors to Coxwell Hall/Mews will be encouraged to complete a Quality Scale Survey in the near future. The training co-ordinator acknowledged the advice given within the previous inspection to include a date for return of response. This will also assist in formulating an action plan to develop the service. The CSCI inspection reports are left beside the Visitors’ Book for information. An audit of resident’s finances showed no discrepancies. Monies received and spent are recorded appropriately. All deposits checked balance with the records held. Resident’s finances and possessions are safeguarded by the efficiency of the home’s administrator. The manager stated that the policies and procedures are in the process of being updated to include guidance regarding sexuality and sexual relationships. Training opportunities for staff include subjects relating to health and safety. Staff members confirmed that knowledge can be updated periodically. Coxwell Hall and Mews Nursing Home DS0000027145.V295636.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 2 3 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 X X X X X X 1 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 2 2 Coxwell Hall and Mews Nursing Home DS0000027145.V295636.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 OP7 Regulation 13[4][c] Requirement Timescale for action 20/06/06 2 3 OP9 OP10 13[2] 12[4][a] The manager must maintain behavioural management plans for residents exhibiting extremely challenging behaviour. The manager must ensure that 23/05/06 all medication received into the home is recorded. The manager must ensure that 23/05/06 the conduct of staff respects the privacy and dignity of residents. Senior staff must attend additional training on POVA. The registered manager must ensure that staff receive training appropriate to their work. The cleanliness, maintenance and hygiene of the home must be reviewed regularly. The manager must send the Commission a copy of the home’s policy on restraint for information. The manager must inform the Commission on each occasion a resident has a serious injury and of any event adversely affecting the well-being or safety of a resident. DS0000027145.V295636.R01.S.doc 4 5 6 7 OP18 OP30 18 18 23[2][d] 17[1][a] Schedule 3 No.3p 37 31/07/06 07/11/06 23/05/06 30/06/06 OP19 OP37 8 OP38 23/05/06 Coxwell Hall and Mews Nursing Home Version 5.2 Page 26 9 OP38 17[2] The manager must maintain a record of all events affecting the health, safety and welfare of residents. 23/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP1 OP3 OP7 Good Practice Recommendations The manager should identify in the Statement of Purpose the type of behaviour the home can or cannot cope with. A senior staff member should meet all prospective residents before their admission as part of the assessment process. Where toileting is necessary staff should ensure that the frequency is recorded in the care plan and that a toileting chart is maintained and completed by staff on each occasion. All personal and mouth care given should also be documented in the care plan. It is recommended that those with a diagnosis of dementia receive an introductory visit from the CPN and regular visits thereafter. • Any alterations made to medication records should be signed by the person making the alteration. • All the necessary policies and guidelines should be easily available for staff managing the medication. • The registered manager should seek guidance from a pharmacist about how best to manage controlled drugs no longer needed for residents still kept at the home. • The registered manager should review the home’s medication policy to reflect guidance regarding the disposal of controlled drugs. • The manager should provide more appropriate telephone facilities for residents’ use. • The registered manager should, whenever possible, use more appropriate training areas for staff other than residents’ communal areas. • The updated statement of purpose should be made available to residents and relatives as soon as possible. DS0000027145.V295636.R01.S.doc Version 5.2 Page 27 4 5 OP8 OP9 6 OP10 Coxwell Hall and Mews Nursing Home 7 8 9 OP14 OP15 OP28 The manager should review restriction of liberty care plans at least six monthly, with the resident or their next of kin and a professional external to the home. Evidence in Care plans should record food preferences on admission and be used for the benefit of individual residents. The registered manager should ensure that the appropriate number of carers with NVQ qualifications are working at the care home. Coxwell Hall and Mews Nursing Home DS0000027145.V295636.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South, Cowley Oxford OX4 2SU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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