Inspection on 12/07/07 for Cubbington Mill

This inspection was carried out on 12th July 2007.

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

Cubbington Mill 16/02/09

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Cubbington Mill Church Lane Cubbington Leamington Spa Warwickshire CV32 7JT Lead Inspector Michelle McCarthy Key Unannounced Inspection 12th July 2007 08:00 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 Cubbington Mill DS0000069239.V339898.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. Cubbington Mill DS0000069239.V339898.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cubbington Mill Address Church Lane Cubbington Leamington Spa Warwickshire CV32 7JT 01926 430351 01926 420854 cubbingtonmill@barchester.net or .com 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) Barchester Healthcare Homes Ltd Deborah Lesley Allen Care Home 56 Category(ies) of Old age, not falling within any other category registration, with number (56), Physical disability (10) of places Cubbington Mill DS0000069239.V339898.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home can accommodate up to 5 service users between 45 and 65 years for end of life care. This is the first inspection of this service since it was registered as Barchester Healthcare Ltd Date of last inspection Brief Description of the Service: Cubbington Mill Care Home is a purpose built home situated in the village of Cubbington, a few miles from Leamington Spa with all its amenities, a variety of shops, pubs and places of worship. The home is registered to provide accommodation and care to residents over the age of 65 who may require nursing care. Since the inspection, the home now has registration to care for up to 5 residents under the age of 65, and a new certificate is to be issued. The home also has specialist registration for the provision of terminal care and ten residents with a physical disability. The homes décor, furniture and furnishings are of a high standard. The accommodation is provided on two floors with access to these via a passenger lift or stairs. The majority of the accommodation is single room with en suite facilities. Four shared rooms are provided for married couples and those who choose share; these rooms are also available to let to residents who express a preference for a larger room in which case these rooms are let as single rooms. The gardens are mature and well maintained, being accessible to all of the current residents. There is a vehicle at the home to transport the residents on trips and for appointments. Information about the home is given to prospective residents and their families via the ‘Statement of Purpose’ and other information brochures. Range of fees: £750 - £850 per week. Additional charges are made for hairdressing, chiropody, toiletries and sundries such as newspapers. Cubbington Mill DS0000069239.V339898.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents. This report uses information and evidence gathered during the key inspection process that involves a visit to the home and looking at a range of information. This includes the service history for the home and inspection activity, notifications made by the home, information shared from other agencies and the general public and a number of case files. This serviced was registered with a new provider, Barchester Healthcare, on 1st February 2007. However, it was previously registered with Westminster Healthcare which was a wholly owned subsidiary of Barchester Healthcare (the new registered provider). Consequently, the organisation and management of the home and the staff group remain unchanged. The service is registered for 56 residents but the manager informed us that they usually accommodate a maximum of 52 people. The visit to the home was made on 12th July 2007 between 9.50am and 6pm. 49 people were living in the home on the day of the visit. It was the assessment of the home manager that majority of people living in the home had medium dependency nursing care needs. Documentation maintained in the home was examined including staff files and training records, policies and procedures and records maintaining safe working practices. A tour of the building and several bedrooms was made. The inspector had the opportunity to meet several residents by visiting them in their rooms, spending time in the communal lounges and talking to several of them about their experience of the home. There was an opportunity to chat socially when the inspector joined residents for their midday meal. General conversation was held with others, along with observation of working practices and staff interaction with the people living in the home. The home manager was present throughout the day. The inspector also spoke to several nursing and care staff and the administrator. The care of three people living in the home was identified for close examination by reading their care plans, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ where evidence of the care provided is matched to outcomes for the people using the service. Cubbington Mill DS0000069239.V339898.R01.S.doc Version 5.2 Page 6 The manager completed the Annual Quality Assurance Audit and returned it to us before this inspection visit. What the service does well: What has improved since the last inspection? What they could do better: Arrangements must be made to ensure prospective residents have a full assessment of their needs and abilities recorded before they move into the home. This is to make sure that prospective residents can be confident that the home can meet their needs. Cubbington Mill DS0000069239.V339898.R01.S.doc Version 5.2 Page 7 Systems must be in place to identify any risk to the health or well being of people living in the home and must include details of how any identified risk can be minimised. This must include the risk of developing pressure sores, falls and entrapment in bedrails to make sure that risks to the health or well being of residents are identified and minimised. Systems must be developed and implemented to ensure that people are given their prescribed medication in the correct dose and accurate records maintained to prevent the risk of harm from medication errors. Arrangements must be made to ensure the safe administration of medicines for people who choose to self medicate to prevent the risk of harm from medication errors Systems must be in place to control the spread of infection to prevent the risk of harm. Arrangements must be made to ensure the safety of essential services and equipment in the home. To include the Fixed Electrical Installation, reducing the risk of scalds from water outlets exceeding temperatures of 43°C and servicing hoists within recommended timescales. This is to promote the safety of people 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. Cubbington Mill DS0000069239.V339898.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cubbington Mill DS0000069239.V339898.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 was assessed. Quality in this outcome area is adequate. The home does not always assess the needs of prospective residents before they move into the home so cannot be sure they can meet their needs. This puts people at risk of not having their needs met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager said that it was usual practice for a senior member of the nursing staff to visit people who are considering moving into the home to undertake an assessment of their needs and abilities. The case files of three people identified for ‘case tracking’ were examined to assess the pre-admission assessment process. Cubbington Mill DS0000069239.V339898.R01.S.doc Version 5.2 Page 10 There was no evidence of a pre admission assessment of need for one resident admitted with complex palliative care needs. Information identifying needs from staff at the previous placement supplemented by a full assessment of need were available on the day of admission to the home. However, the home must be sure that they can meet a person’s needs before they move into the home to avoid an oversight of care. The resident was not admitted in an emergency situation but it was the preference of the family that the person be accommodated at Cubbington Mill as soon as possible. There was evidence of full and comprehensive needs assessment in the other two case files examined. Information gathered about the needs and abilities of people living in the home is used to develop care plans to meet these needs. One resident spoken to said that they had chosen Cubbington Mill with the help of family who visited the home before they were admitted. The person said they had sufficient information about the home to decide whether it was what they were looking for. Cubbington Mill DS0000069239.V339898.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 were assessed. Quality in this outcome area is adequate. Residents are treated respectfully and their dignity is upheld. Care plans are not consistently developed to address the identified needs of people living in the home which puts them at risk of not having their needs met. Systems for the management of medication are not sufficient to protect residents from the risk of harm from medication errors. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Observations during the key inspection visit found that people living in the home looked well cared for and were clean, their hair had been combed and nails were trimmed and clean. They were well presented and wore clothes that were suited to the time of year. It was evident from observation that the personal care needs of people living in the home are met. Three people were identified for ‘case tracking’. Cubbington Mill DS0000069239.V339898.R01.S.doc Version 5.2 Page 12 Each person had a care plan, daily records and monitoring records. Care plans were generally based on information secured during the initial care needs assessment. There was evidence of monthly reviews of each care plan. Evaluation of the care given is documented in the daily progress sheets using a numbered cross-referencing system. The service uses risk assessment for falls, nutrition and pressure sores. Each person’s case file contained a record of contact with or visits by Health Care Professionals. These confirmed that people living in the home are referred to a doctor when a change in their health is noticed. Evidence was available in case files that the care planned for people living in the home is discussed and reviewed with their relatives or representatives so they are aware of and can agree the care the service gives to their loved one. Examples of good practice in care planning and meeting residents health care include: • A short term care plan was developed and implemented for a person when they were found to have a skin tear. The care plan was reviewed within the timescale set discontinued when the need resolved. Routine urinalysis identified a possible urinary tract infection which was referred to the GP for investigation Monthly weight monitoring for one resident identified a weight loss of 6Kg over three months. A referral to the GP was made and fortified supplementary drinks were prescribed. One person admitted to the home with pressure sores had a care plan for dressings and pressure relief. Wound assessment charts and photographs were available to ‘map’ the progress of the wounds. • • • Examples of shortfalls in care planning and meeting residents health care include: • A risk assessment for one resident identified a high risk of developing pressure sores but no care plan was developed to minimise the risk. One resident was identified as having a low risk of falls when they were admitted to the home but two incidents of falls were recorded in the two weeks following their admission. The risk assessment was not reviewed despite the increased risk evidenced by further falls. Consequently, there was no care plan developed to minimise the risk. • Cubbington Mill DS0000069239.V339898.R01.S.doc Version 5.2 Page 13 • The use of bedrails is not consistently risk assessed. A ‘check list’ for safe use of bedrails was available in the case file of one person using bedrails but was absent in another. The home must be able to demonstrate that the use of bedrails is implemented in residents’ best interest and take action to minimise the risk of entrapment. Documentation in one resident’s ‘End of life’ file recorded a discussion with family but not the resident about their wishes. One recently admitted resident had not been weighed so staff have no baseline to compare any possible gain or loss in the future. This means staff are unable to monitor the person’s weight which may reflect their general well being. • • The systems for the management of medicines in the home were examined. A monitored dosage (‘blister packed’) system is used. Medication is safely stored in locked trolleys which are kept in locked rooms . A medicines fridge is available with daily recordings of the temperature which is within recommended limits. The facility for storing controlled drugs is satisfactory. A controlled drug register is accurately maintained. The contents of the controlled drug cabinet was audited and was correct. Medicine administration records were generally accurately maintained. One resident was prescribed four dexamethasone 2mg tablets to be taken daily. Records in the case file document a telephone instruction taken from the Macmillan nurse to increase the prescription to eight dexamethasone 2mg tablets daily for five days. The changes were handwritten on the MAR sheet and did not give clear instructions as to whether 8 tablets or 8mg were to be given. An audit of Megace tablets prescribed for one person recorded that 28 were received into the home and 20 tablets were signed as being administered. There should have been 8 tablets remaining but 12 were counted. This suggests that four tablets were signed for but not given. The home has a written policy and procedure for arrangements for residents to self medicate but evidence was available to indicate that these are not followed. One resident is self medicating but nursing staff had not fully completed a risk assessment for this and had not made any compliance checks. This increases the risk of harm due to error. People living in the home were observed to be treated with respect and their dignity maintained; for example, personal care was provided in private and Cubbington Mill DS0000069239.V339898.R01.S.doc Version 5.2 Page 14 residents were spoken to respectfully. During observation of working practice it was evident that staff are knowledgeable about the likes and dislikes of people living in the home and were kind, caring and attentive towards them. Cubbington Mill DS0000069239.V339898.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): Standards 12, 13, 14 and 15 were assessed. Quality in this outcome area is good. Some of the people living in the home are supported to maintain their independence and enduring interests which enhances their quality of life. Residents benefit from a varied and nutritious diet and enjoy their meals as a social occasion. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs an activities co-ordinator for 30 hours each week to provide a planned activity programme throughout the week The life histories of residents were seen in some of the case files and gave staff information about their background and enduring interests and relationships. This should enable the activity co-ordinator to plan a programme that reflects the interests of the people living in the home. There is a regular activity programme available, which is changed and displayed weekly. One resident said, ‘There’s plenty to do, always something going on that you can join in with if you want.’ Cubbington Mill DS0000069239.V339898.R01.S.doc Version 5.2 Page 16 The home supports the people living there to have visitors at any time. Residents spoken to said their visitors were always made welcome. The inspector joined residents for the midday meal. Four residents remained in the lounge for their meal and some chose to have their meal in their rooms. Remaining residents enjoyed their meal in the restaurant-like surroundings of the dining room. Some people were joined by their relatives. Tables were beautifully set with linen tablecloths, slip cloths, flowers and condiments. Residents are told on a daily basis what is the choice of the day and their orders taken. Alternatives are also available if residents do not like the choice of the day. The choice of meal was pork steak or vegetable quiche accompanied by carrots, sweetcorn and mashed potatoes followed by chocolate sponge and custard. A choice of fruit juice was offered. The meal was well presented, nutritious and tasty. Residents made positive comments about the quality of food in the home. They told the inspector that the dining room was used for the midday meal. Breakfast was usually served to individuals in their rooms, ‘you can have whatever you like for breakfast’, one person said, this included a choice of cooked breakfast. People were given discreet, sensitive assistance to eat their meals. There was a calm ambience at lunchtime and a feeling that the midday meal was an enjoyable, social occasion. Cubbington Mill DS0000069239.V339898.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): Standards 16 and 18 were assessed. Quality in this outcome area is good. People living in the home can be confident that their concerns will be listened to and acted upon. The home’s procedure’s and staff training in abuse awareness safeguard people from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a formal complaints policy which is accessible to service users and their families. People are encouraged to raise their concerns with the manager. We have not received any complaints about this service in the last 12 months. A record of complaints received by the home is maintained along with the action taken by the home regarding each issue raised. The service has recorded 10 complaints in the last 12 months. These include concerns raised about the food service on New Years Day, poor positioning of a resident in their wheelchair, issues about care practices and the suitability of equipment (an electric reclining chair). The manager records concerns raised verbally or informally and these are taken as seriously as concerns that are expressed in writing. Cubbington Mill DS0000069239.V339898.R01.S.doc Version 5.2 Page 18 Evidence was available that the provider makes a timely and objective response to concerns raised. When the manager is unable to resolve the complaint locally or considers the complaint to be particularly serious, it is referred to her line manager. The inspector spoke with one resident and their relative who had recently raised several concerns. The person said that each of them had been addressed and while the person did not feel completely satisfied with the outcome, they could not deny that the concerns had each been taken seriously and management and staff had done their best to achieve resolution as soon as practicable. The home has an adult protection policy to give staff direction in how to respond to suspicion, allegations or incidences of abuse. It was evident through discussions with the manager that she is aware of local Social Services and Police procedures for responding to allegations of abuse. Most staff have received abuse awareness training. Cubbington Mill DS0000069239.V339898.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): Standards 19 and 26 were assessed. Quality in this outcome area is good. Residents are provided with clean, attractive, well furnished and comfortable surroundings to live in and enjoy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Cubbington Mill provides accommodation in mostly single rooms with ensuite facilities on the ground and first floor. The home is well presented with a good standard of decoration throughout. The home is clean and free from unpleasant odours. There are several communal lounges over the two floors and several other smaller seating areas. Residents and their relatives were seen making use of Cubbington Mill DS0000069239.V339898.R01.S.doc Version 5.2 Page 20 all the space available. The home’s dedicated dining room, located on the ground floor has been completely refurbished in the last year and has a ‘restaurant’ feel to it . The bedrooms of three people involved in case tracking were viewed and varied in the standard of accommodation provided. One single room was beautifully decorated and furnished with mahogany coloured furniture and co-ordinating bedding and curtains providing a cosy and welcoming environment. Another single room appeared quite stark and dated. The resident of this room was recently admitted and told the inspector that the sheets on the bed were ripped and creased on the day of admission. Some residents had taken the opportunity to personalise the room with their own belongings so it looked like ‘theirs’. One shared room was seen. One of the people accomodated in this room had an MRSA wound infection. Clinical waste bags containing soiled dressings, used handtowels and protective clothing were stored in the shared ensuite bathroom. There was no evidence of ensuring the bathroom was restricted for the sole use of one person or alternative arrangements for the other preson in the room to use another bathroom. This presents a risk of cross infection. Equipment used for manual handling, and spare wheel chairs are stored in two of the current shower rooms, which the manager said were not used by the residents and she would like to convert to storage facilities. The manager said that bathrooms, which are used regularly by residents but are also used for storage of equipment, were always cleared before use. Various types of pressure relieving mattresses were observed in use, but one person nursed in bed was lying on an alternating cell ‘Quattro Overlay’ mattress designed for use with the existing mattress on the bed. It was noted that the overlay mattress was not used in conjunction with a standard mattress but was used as a replacement mattress. This was brought to the attention of the manager who committed to investigate the correct use. The home employs maintenance and gardening personnel. The home is well maintained, and the gardens are well kept and provide good additional outside space for residents to use. The home has a modern, well-organised laundry room with dedicated laundry staff. All the residents seen on the day of this visit wore well laundered and pressed clothes. Cubbington Mill DS0000069239.V339898.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): Standards 27, 28, 29 and 30 were assessed Quality in this outcome area is good. There are sufficient numbers of staff on duty to meet the needs of people living in the home and robust pre employment checks safeguards people from risk of harm from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager informed the inspector that the usual staffing complement for 52 residents is: 7.30am – 2.30pm 2.30pm – 9.30pm 9.30pm – 7.30am 2 registered nurses and 10 care staff 2 registered nurses and 6 care staff 2 registered nurses and 3 care staff Cubbington Mill DS0000069239.V339898.R01.S.doc Version 5.2 Page 22 The manager is supernumerary and there are sufficient laundry, catering, cleaning, maintenance and administrative staff to ensure that care staff do not spend undue lengths of time undertaking non-caring tasks. Two weeks of the home’s duty rota between 1st and 14th July 2007 was examined and demonstrated that the staffing levels set by the home (in the table above) are usually achieved. It was evident from the appearance of people living in the home that there are sufficient staff on duty to meet their personal care needs. Out of 25 care staff employed in the home 6 have a National Vocational Qualification in Care (NVQ) at level 2 or above which, at 24 , is well below the National Minimum Standard for 50 of staff to be qualified. Six of the remaining care staff employed in the home have an overseas nursing qualification, which is not valid with the UK’s Nursing and Midwifery Council (NMC). The service is unable to demonstrate that the overseas nursing qualifications are equivalent to NVQ at level 2 or above and therefore cannot be included in the numbers of care staff with an NVQ qualification. The personnel files of two recently recruited staff were examined and both contained evidence that satisfactory checks such as Criminal Record Bureau (CRB), Protection of Vulnerable Adult (PoVA) and references are obtained before staff commence employment in the home. Robust recruitment procedures and pre-employment checks should protect the vulnerable people living in the home. Staff training records demonstrate that staff complete an induction programme and receive mandatory training in Health and Safety, Customer Care, Infection Control, Fire Training, Moving and Handling, Abuse Awareness and Food Safety. Some staff require training or updates in mandatory training but the manager maintains a monitoring system which identifies these staff so that training can be arranged. Cubbington Mill DS0000069239.V339898.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): Standards 31, 33, 35 and 18 were assessed. Quality in this outcome area is adequate. Residents benefit from living in a home managed by a competent person and where working practices are audited and reviewed to promote continuous improvement. However, Systems for maintaining essential services and equipment are not always sufficient to promote the health and safety of people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post for 2 years and is registered with Commission for Social Care Inspection. She is registered general nurse and has the Registered Manager’s Award (NVQ Level 4). Cubbington Mill DS0000069239.V339898.R01.S.doc Version 5.2 Page 24 The service has undertaken it’s own clinical audits of care in June 2006. The audits have identified areas for improvement and action plans. Evidence was available of the way the home seeks the opinion of residents and relatives to make sure they have a say in the way the home is run. Opinions were surveyed in November 2006. Evidence was available that the responses were analysed, published and action plans developed for points raised. Minutes of resident and relative meetings were recorded for the meetings in February 2006, August 2006 and April 2007. The service does not hold service users’ personal monies or valuables for safe keeping so standard 35 is not applicable and was not assessed. Service users are invoiced for additional costs such as hairdressing or chiropody A sample of records were examined to assess the home’s systems for maintaining equipment and services. Some of these did not adequately promote the safety of people living in the home. For example, • The Fixed Electrical Installation Inspection certificate (‘5 year electrical check’) was issued in 2004 was ‘unsatisfactory’. There was no evidence available of remedial work to ensure it was safe. Labels on hoists indicated they were last serviced in December 2006 so the 6 monthly check is now overdue. The manager was unable to provide evidence of further inspection or service of the hoists since December 2006. Hot water outlet temperatures are recorded monthly and were noted to exceed the recommended limit of 43°C.The manager must investigate the cause of this and take action to minimise the risk of scalds for people living in the home. • • Other records sampled demonstrated that • Fire alarm systems are checked weekly to ensure they are in working order. Portable Electrical Appliances tests were undertaken in May 2007 • The home’s programme of mandatory training protects the safety of people in the home but staff who do not have current mandatory training need to be updated to make sure this is consistent. Cubbington Mill DS0000069239.V339898.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 X X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X N/A X X 2 Cubbington Mill DS0000069239.V339898.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 Standard OP3 Regulation 14 Requirement Arrangements must be made to ensure prospective residents have a full assessment of their needs and abilities recorded before they move into the home. This is to make sure that prospective residents can be confident that the home can meet their needs. Care plans must be available for each of the identified needs of people living in the home and contain details of the actions required to meet each need. This is to make sure that people get the care they need. Systems must be in place to identify any risk to the health or well being of people living in the home and must include details of how any identified risk can be minimised. This must include the risk of developing pressure sores, falls and entrapment in bedrails. This is to make sure that risks to Cubbington Mill DS0000069239.V339898.R01.S.doc Version 5.2 Page 27 Timescale for action 30/09/07 2 OP7 15 30/09/07 3 OP8 12 30/09/07 4 OP9 13(2) the health or well being of residents are identified and minimised. Systems must be developed and implemented to ensure that people are given their prescribed medication in the correct dose and accurate records maintained. This is to prevent the risk of harm from medication errors Arrangements must be made to ensure the safe administration of medicines for people who choose to self medicate. This is to prevent the risk of harm from medication errors. Systems must be in place to control the spread of infection. This is to prevent the risk of harm from infection. Arrangements must be made to ensure the safety of essential services and equipment in the home. To include: A satisfactory Fixed Electrical Installation certificate confirming the safety of the electrical wiring must be available for inspection in the home. Action must be taken to reduce the risk of scalds from water outlets exceeding temperatures of 43°C Hoists must be serviced within recommended timescales This is to promote the safety of people in the home. 31/08/07 5 OP9 13(2) 31/08/07 6 OP26 13 30/09/07 7 OP38 13 30/09/07 Cubbington Mill DS0000069239.V339898.R01.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 Refer to Standard OP28 Good Practice Recommendations The service should be able to demonstrate that 50 of care staff have a National Vocational Qualification in Care at level 2 or equivalent. This is to ensure that people living in the home are cared for by competent staff. Cubbington Mill DS0000069239.V339898.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Cubbington Mill DS0000069239.V339898.R01.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. 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