Inspection on 08/01/07 for Coxwell Hall and Mews Nursing Home

This inspection was carried out on 8th January 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... 20/12/07

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

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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 8th January 2007 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 Coxwell Hall and Mews Nursing Home DS0000027145.V327018.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.V327018.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 (68), Mental Disorder, excluding registration, with number learning disability or dementia - over 65 years of of places age (37) Coxwell Hall and Mews Nursing Home DS0000027145.V327018.R01.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 23rd May 2006 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. At this time fees ranged from £589 to £850 per person per week. Extras include hairdressing, chiropody, newspapers and toiletries. Coxwell Hall and Mews Nursing Home DS0000027145.V327018.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 a second unannounced ‘Key Inspection’. Two inspectors, arrived at the service at 09.30am and were in the service for seven and a half 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 60. The inspectors looked at how well the service was meeting the standards set by the government for Older People and have in this report made judgements about the standard of the service. Since the last inspection the home has increased the number of residents with dementia it can care for by 31 to enable it to specialise fully in the care of those with a dementia. Special arrangements have been made for those residents without a dementia to enable them to continue living at the home. From the evidence seen by the inspector and the comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. 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. Three residents responded to a questionnaire, 66 of those residents who responded to these confirmed that they received a contract, 66 that they had enough information before moving into the home, 66 that they always received the care and support they needed and 33 that they usually did; 100 confirmed that staff listened and acted on what they said, 66 that staff were always available when needed and 33 that they usually were; 66 that they always received the medical support they needed and 33 that they usually did; 33 confirmed that there were always activities arranged by the home that they could take part in and 66 that there sometimes were; 33 confirmed that they always liked the meals at the home, 33 that they usually did and 33 that they sometimes did; 66 confirmed that they always knew who to speak to if they were not happy and 33 that they usually did; 66 confirmed that they always knew how to make a complaint and 33 that they usually did; 33 confirmed that the home was always kept fresh and clean, 33 that it usually was and 33 that it sometimes was. Their comments included – “They are very kind to me. [Activities] I sometimes like to stay in my room. [Food] They always give me what I ask for. I am very happy here. I have a lovely room. They clean my room every day, sometimes more if needed.” “I did not receive enough information about the home Coxwell Hall and Mews Nursing Home DS0000027145.V327018.R01.S.doc Version 5.2 Page 6 because it was an emergency placement.” “Activities at Coxwell Hall have for some time been lacking and in my mind have only just started to be addressed. The home’s freshness and cleanliness is being addressed and under refurbishment.” One social and healthcare worker responded to a questionnaire. This person confirmed that there was always a senior member of staff to confer with, that s/he was able to see his/her client in private, that staff demonstrated a clear understanding of residents’ care needs, that any specialist advice given is incorporated into the resident’s care plan, that residents’ medication was appropriately managed in the home, that management/staff took appropriate decisions when they could no longer manage residents’ care needs, that the CSCI inspection reports were made available to them on request and that they were satisfied with the overall care provided to residents at the home. This social and healthcare worker had not received any complaints about the home.” This person commented, “The staff have been working closely with myself and the community psychiatric nurse to manage the needs of my client and following new medication prescribed by the GP my client is now very settled and a recent review indicated the staff have not encountered any problems in delivering the care and are meeting all assessed needs satisfactorily.” Eight relatives/visitors responded to questionnaires. 100 of relatives/visitors who responded to questionnaires confirmed that they were made welcome in the home at any time, that they could visit their relative or friend in private and that they were kept informed of important matters affecting their relative/friend, 75 felt that they were consulted when their relative/friend was unable to make decisions about their care, that there were always sufficient staff on duty and that they had access to a copy of the inspection reports on the home. 61 were aware of the home’s complaints procedure and 50 had made a complaint. 100 were satisfied with the overall care provided by the home. Comments included, “This is not a complaint but I feel my mother needs more one to one help with her midday meal. I realise she can be difficult and tends to throw her food at lunch time but maybe more help with feeding would solve the problem. There is no problem with breakfast and supper.” “The disgusting state of the car park is of considerable inconvenience as you cannot enter the home without getting wet feet and covered in mud”. Another relative commented similarly. “The care home looks so much better after refurbishment, namely new carpets and furniture in the dining room and lounge. This was much needed. I must also praise the staff on their work”. 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.V327018.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. There is a range of activities showing an attempt to recognise residents’ preferences and interests. The recent refurbishment has made the home much more attractive, comfortable and homely and provides a range of lounge and dining areas for residents’ use. Most bedrooms have en suite WCs. Residents expressed satisfaction with the standard of accommodation provided. Residents’ financial interests are safeguarded. What has improved since the last inspection? What they could do better: Develop a formal plan of care for all health problems and ensure that all entries are signed and dated. The home should record in the care plan that residents and their families have been involved in developing their care plans. The home should also ensure that a plan of care is developed to meet all the identified healthcare needs of each resident. It is recommended that two people countersign handwritten entries of any antibiotics prescribed mid-cycle to ensure that they are transcribed correctly from the original container dispensed by the pharmacist. It is recommended that the home consider recording the use of Temazepam in the controlled Coxwell Hall and Mews Nursing Home DS0000027145.V327018.R01.S.doc Version 5.2 Page 8 drugs register and that the pharmacist be asked to undertake a regular audit of the medication management in the home. 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.V327018.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.V327018.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All residents now have their needs properly assessed before moving to the home to ensure it can meet their needs. EVIDENCE: The Statement of Purpose was reviewed recently in respect of the behaviours the home is able to accommodate. A copy of this must be submitted to the CSCI for information within 28 days. Five residents were case tracked. Four had evidence in their care plan that their needs had been pre-assessed prior to their moving into Coxwell Hall and Mews. The pre-assessment documentation contained the detail described in Standard 3 of the National Minimum Standards. The one resident who did not have any pre-assessment documentation had moved to the home in 2005 and the manager confirmed that practice has changed since then and that all residents are now assessed prior to moving to the home. One resident was Coxwell Hall and Mews Nursing Home DS0000027145.V327018.R01.S.doc Version 5.2 Page 11 spoken to and she confirmed that she had been visited in hospital before she moved to the home. One family member was also spoken to and confirmed that they had been visited at home and had the opportunity to visit the home before their mother moved. They felt that she had been made welcome and that her immediate needs were being met. Neither intermediate care nor respite care is provided. Coxwell Hall and Mews Nursing Home DS0000027145.V327018.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst health care needs are met these need to be recorded fully to ensure they are met consistently. Residents’ mental health and emotional needs are met and for the most part residents’ right to privacy is respected. EVIDENCE: The home operates a key worker system where the care needs of individual residents are the responsibility of two identified members of staff. The staff spoken to confirmed that all residents had care plans and that where toileting is necessary a toileting chart is maintained and completed by staff on each occasion. Staff spoken to confirmed that any mouth care given is also documented in the care plan. The five care plans examined had improved since the last inspection. All had an assessment of needs and risk assessments covering moving and handling, nutrition and falls. All had had at least one review since being written and three had been reviewed on a monthly basis. There was evidence in the daily Coxwell Hall and Mews Nursing Home DS0000027145.V327018.R01.S.doc Version 5.2 Page 13 entries of some that the residents had other problems for which a formal plan of care had not been developed. Most but not all entries had been signed and dated. The resident spoken to and the family member spoken to said that they had been asked about their care needs although this was not recorded in the care plans. The care plans showed that residents had been assessed as to their risk of developing pressure damage and that the assessments had been updated regularly. None of the residents reviewed had pressure damage. Staff spoken to also confirmed that the turning of residents regularly to protect their pressure points is now recorded. The staff are trained to assess residents’ continence difficulties and the local Primary Care Trust provides aids. The five care plans examined had evidence that residents’ nutritional needs had been assessed and that residents are weighed regularly. Four of the five residents’ weights had remained stable. One had lost weight and he had been prescribed supplementary drinks to provide additional calories. There was evidence in the care plans that the General Practitioner visits regularly. There was evidence from the general practitioners notes about problems that residents had developed which were not recorded in the care plan. For instance one gentleman had a chest infection. This was not recorded in the care plan, although he had commenced antibiotic treatment and the staff were aware that he had a chest infection. His healthcare needs were being met although not recorded in full. Staff reported improved joint working with the community psychiatric services and GPs since the last inspection. One resident had challenging behaviour and appropriate advice had been sought and a care plan developed. The staff said that this had helped them to meet his needs better. Two registered mental health nurses have been employed since the last inspection to develop staff skills in responding to challenging behaviour. It was reported that behavioural management plans are now in place for those residents exhibiting extremely challenging behaviour. Staff reported becoming more skilled at identifying agitation and in preventing behavioural problems such as violence than had hitherto been the case. There is a medication policy in place, which was last updated in August 2006. The staff were aware of the policy and also had copies of the Nursing and Midwifery Council and Royal Pharmaceutical Societys guidance on medication management. Records are kept of the signatures of nurses who administer medication. Records are kept of medication entering and leaving the home. The medication administration records were completed correctly. A daily audit is undertaken and any gaps are explored and corrected. There were some handwritten entries of antibiotics, which had been prescribed mid-cycle. It is recommended that two people countersign these entries to ensure that they are transcribed correctly from the original container, dispensed by the pharmacist. Coxwell Hall and Mews Nursing Home DS0000027145.V327018.R01.S.doc Version 5.2 Page 14 Controlled drugs are stored correctly. Temazepam is stored in the controlled drugs cupboard but its use is not recorded in the controlled drugs register. It is recommended that the home consider this. The pharmacist does not currently undertake a regular audit of the medication management in the home, which is also recommended. 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. Evidence was seen that risk assessments are updated at the same time as care plans are. Where required, appropriate equipment is provided. An inspection of the laundry indicated that communal supplies of tights and stockings and socks are no longer kept and all laundry is marked with the name of the resident so that residents always wear their own clothing at all times. The laundry area in the Mews was seen to be well organised and a staff member confirmed that residents do not share any items of clothing and that these are all individualised. This maintains residents’ dignity. The inspector observed staff working patiently and kindly with residents with dementia and treating them with care, dignity 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. Training sessions for staff are still conducted in an area designated for use by residents. An amendment has been made to the home’s Statement of Purpose to show that residents’ communal areas might be used for staff training sessions. It is recommended that additional consideration be given to how training can best be provided without compromising residents’ communal living space. Coxwell Hall and Mews Nursing Home DS0000027145.V327018.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The visiting arrangements are good and there are organised activities for residents. The arrangements for food and drinks ensure residents have a choice. EVIDENCE: The home had only one activities coordinator for several months but a second activities co-ordinator started work on the day of this inspection. The activities undertaken within the home recently have therefore been restricted but have included a mobile library, one to one and group activities, entertainers, outings and walks. A magician recently visited the home. Discussion with the new activities co-ordinator indicated that he was keen to introduce a range of activities, which recognises residents’ preferences and interests. A hairdresser visits the home regularly. Staff spoken to about activities confirmed that all residents now have individual social histories and individual activities plans completed with the individual and with their family members and staff, if possible. Coxwell Hall and Mews Nursing Home DS0000027145.V327018.R01.S.doc Version 5.2 Page 16 The home’s policy regarding visitors is stated in the Statement of Purpose, and visitors are made to feel welcome. The visitors seen in the home appeared relaxed and comfortable with being there and had easy access to their friends and/relatives. More appropriate telephone facilities have been provided in one quiet lounge for residents’ use. Individual preferences are respected. One resident who enjoys sleeping until 11am has a bowl of porridge served to him in his room after he awakens. The chef is undertaking NVQ training to develop her skills. Menus are displayed on the small dining room tables and on the day of inspection a choice between pork chops and beef stroganoff was available for lunch. Foods are prepared to suit differing needs, such as pureed for those with swallowing difficulties, and are presented appropriately. Several residents spoken to spoke highly of the food. Coxwell Hall and Mews Nursing Home DS0000027145.V327018.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The complaints procedure meets the requirements of the Regulations and is prominently displayed. Staff have received additional training to ensure they respond promptly and appropriately to allegations of abuse. More stringent pre-employment checks are needed to fully safeguard residents. EVIDENCE: A complaints log is kept. The home received one complaint over a 12-month period. This was partially substantiated and responded to within the required timescale. No complainant has contacted the CSCI with information concerning a complaint about the service since the last inspection. The organisation is now making the required notifications of events in the home, which affect the welfare, and safety of residents. The home is now diligently informing the CSCI whenever a serious injury or any event adversely affecting the well-being or safety of any resident occurs. There are protection of vulnerable adult policies and procedures in place. The last inspection report highlighted a need for senior staff to have additional training in the protection of vulnerable adults from abuse. The staff have had safeguarding adult training over the last year. Three training sessions have been held in June, July and October, which most staff attended. Both the manager and the deputy manager attended training on safeguarding adults from abuse at level 2. Two members of staff were spoken to and they demonstrated knowledge of Coxwell Hall and Mews Nursing Home DS0000027145.V327018.R01.S.doc Version 5.2 Page 18 the principles of safeguarding older people. They also said that they would not hesitate to report concerns and felt that both the manager and deputy were approachable. One member of staff was employed prior to a POVA [Protection of Vulnerable Adults] First and full CRB [Criminal Records Bureau] checks being received. This is discussed further in the Staffing section of this report. Coxwell Hall and Mews Nursing Home DS0000027145.V327018.R01.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): 19,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides comfortable, attractive indoor facilities but the car park requires some attention. The home is kept clean, pleasant and hygienic and residents’ safety is maintained in all areas of the home. EVIDENCE: Since the last inspection a considerable amount of refurbishment has been undertaken in respect of WCs, en suite facilities, bedrooms, lounges, dining rooms, and new separate day spaces have been provided in the Hall for those with a dementia and those without. New flooring and equipment have been provided in the kitchen and various areas in the home have been redecorated. Some areas around radiators and walls and paintwork showing wheelchair damage need redecoration. There is now an activities/sensory room and one quiet room is now equipped with a payphone for residents’ use. In the Mews, the corridors, lounges and dining areas and some bedrooms have been Coxwell Hall and Mews Nursing Home DS0000027145.V327018.R01.S.doc Version 5.2 Page 20 recarpeted, as have the corridors in the Hall. The lighting has been improved in some rooms and new dining room furniture purchased. These improvements have made the home much more attractive, comfortable and homely. The fire precautions were seen to be observed at this time. Security has been improved by the fitting of an additional keypad at one exit on the ground floor in the Mews. With the exception of the pot-holed and muddy car park the external appearance of the home and the gardens were attractive. There has been an enormous improvement in the freshness of the home since the last inspection. This is attributable to the fact that many of the home’s areas have been recarpeted. Coxwell Hall and Mews Nursing Home DS0000027145.V327018.R01.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): 27,28,29,30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are sufficient staff to meet residents’ needs. The training programme has improved, enabling staff to acquire the knowledge and skills to care for residents with specific needs. In general the recruitment procedures are good but one example of poor practice was found which could put residents at risk. EVIDENCE: The staffing rota examined indicated that between two and four registered nurses in addition to between seven to nine care staff were usually on duty in addition to ancillary staff. All staff spoken to at this time confirmed that this level of staffing was adequate to enable them to carry out their duties. The night staffing rota examined indicated that at least two registered nurses and either four or five care staff were usually on duty overnight. The staff training files examined showed that considerable effort has been put into staff training since the last inspection. Training has been held to meet the mandatory basic training requirements and additional training has been offered to staff in diabetes awareness, eyesight in the elderly, End of Life care, dementia care and breakaway training. The staff spoken to about the training were satisfied with this and confirmed that it was adequate to ensure they always worked within their areas of competence. Coxwell Hall and Mews Nursing Home DS0000027145.V327018.R01.S.doc Version 5.2 Page 22 Of the 22 care staff at the home only five are trained to NVQ Level 2 or an equivalent standard. This means that approximately 23 of the care staff are appropriately qualified, instead of the recommended minimum of 50 . However, it was reported that an additional three staff are currently undertaking such training and that another seven staff will commence this in January 2007. One member of staff is undertaking training to be an NVQ assessor. Four recruitment files were examined. All but one contained the required information to demonstrate that appropriate checks had been made prior to the staff member commencing work. However one staff member had started work prior to the POVA First check being received. Her recruitment file shows her start date as 06/04/06. The POVA First check was dated 24/04/06 and the full Criminal Records Bureau check was dated 22/05/06. The rotas show that she was working with residents from 11/04/06. The induction programme for those staff that are undertaking the National Vocational Qualification in Care at Level 2 meets Skills for Care standards. The home has a training programme and the group-training manager from the organisation provides training on a regular basis. Coxwell Hall and Mews Nursing Home DS0000027145.V327018.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improved leadership, guidance and direction are now being given to staff to ensure residents with a dementia receive appropriate care. The home promotes and protects residents’ health and safety and their finances. Regular reviews of the overall quality of the service provided are conducted to ensure the home is run in residents’ best interests. EVIDENCE: The manager is registered with the CSCI and is accountable for the service along with the Responsible Individual of Sovereign [Coxwell Hall] Ltd. The Responsible Individual is now the Director of Nursing for Sovereign Care Homes Ltd. One staff member commented, “The Company needs to listen Coxwell Hall and Mews Nursing Home DS0000027145.V327018.R01.S.doc Version 5.2 Page 24 more. We are here every day and know what needs doing. The Company needs to react quicker. Getting changes can be a longwinded process.” Whilst the registered manager is not qualified to care for those with a dementia or a mental disorder she has had some experience of this and since the last inspection two registered mental nurses have been employed to promote good practice in these areas. A deputy manager has been appointed since the last inspection and this has resulted in management being able to monitor the home’s practices more effectively and to improve care standards. Evidence was seen that the home is increasingly protecting residents’ safety from the violent behaviour of those residents with a dementia or mental disorder and that the CSCI are now being routinely informed of such occurrences as required by the Regulations. The Responsible Individual makes unannounced monthly visits to the home to talk to staff and residents and to monitor how the home is being conducted. The quality of care plans; medication administration records, recruitment and staff records are monitored during these visits. The home carries out a regular review of the quality of service provided involving residents/their representatives and professionals associated with the home. The last of these indicated that professionals have a high regard for the appearance, attitude, support, assistance, willingness to help and caring approach of staff. The CSCI inspection reports are left beside the Visitors’ Book for the benefit of visitors to the home. An audit of residents’ finances showed no discrepancies and monies received and spent are recorded appropriately. Resident’s finances and possessions are safeguarded by the efficiency of the home’s administrator. The home’s policy on restraint is comprehensive. The registered 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 registered manager also confirmed that all the recommended policies and procedures are available and that these were reviewed recently. Coxwell Hall and Mews Nursing Home DS0000027145.V327018.R01.S.doc Version 5.2 Page 25 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 2 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 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Coxwell Hall and Mews Nursing Home DS0000027145.V327018.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP1 OP7 Regulation 4 17 Requirement Submit a copy of the Statement of Purpose to the CSCI within 28 days. Develop a formal plan of care for all health problems and ensure all these entries are signed and dated. Ensure healthcare needs are recorded in full. Ensure all staff members are POVA First checked before commencing employment. Timescale for action 28/02/07 31/01/07 3 4 OP8 OP29 17 19 31/01/07 31/01/07 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 OP7 OP7 Good Practice Recommendations It is recommended that the Statement of Purpose identifies the type of behaviour the home can or cannot accommodate. It is recommended that healthcare needs be recorded fully. It is recommended that care plans evidence that residents DS0000027145.V327018.R01.S.doc Version 5.2 Page 27 Coxwell Hall and Mews Nursing Home 4 5 6 7 8 OP9 OP9 OP9 OP10 OP30 and/their representatives are consulted about these. It is recommended that two people countersign handwritten entries of any antibiotics prescribed mid cycle. It is recommended that the home consider recording the use of Temazepam in the controlled drugs register. It is recommended that the pharmacist be asked to undertake a regular audit of the medication management in the home. It is recommended that more appropriate training areas be used for staff training other than residents’ communal areas. It is recommended that the recommended ratio of carers with NVQ qualifications be achieved as soon as possible. Coxwell Hall and Mews Nursing Home DS0000027145.V327018.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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.V327018.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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