Inspection on 12/05/05 for Culworth House Nursing Home

This inspection was carried out on 12th May 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Culworth House Nursing Home 09/10/08

Culworth House Nursing Home 19/10/06

Culworth House Nursing Home 22/11/05

Culworth House Nursing Home 25/10/04

Culworth House Nursing Home 29/06/04

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

CARE HOMES FOR OLDER PEOPLE Culworth House Nursing Home Queens Street Culworth Banbury Oxfordshire OX17 2AT Lead Inspector Linda Preen Unannounced Thursday 12th May 2005 at 10.00am 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 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. Culworth House Nursing Home Version 1.10 Page 3 SERVICE INFORMATION Name of service Culworth House Nursing Home Address Queens Street Culworth Banbury Oxfordshire OX17 2AT 01295 768377 01295 768201 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Culworth House Partnership CRH 35 Category(ies) of OP Older People registration, with number PD Physical Disability of places Culworth House Nursing Home Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 25th October 2004 Brief Description of the Service: The Home is situated in 4 acres of secluded gardens in the centre of a rural village. It provides accommodation for up to 35 elderly residents. The accommodation is provided in mainly single rooms with two companion rooms available for those who wish to share. It provides 24 hour nursing and personal care. Culworth House Nursing Home Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a period of four hours as part of the statutory inspection programme. Two residents were chosen in order that their experience in the home could be monitored. This included looking at their records, talking to them and also to the staff concerning the care received. In addition to this, Complaints, fire and accident records were seen. 3 complimentary comment cards had been received from residents and 9 from relatives, 4 of which were complimentary, 4 of which commented on the perceived lack of staff and 1 which raised concerns about the food, laundry, communication, and delays in obtaining medical care. Information was available from a questionnaire completed by the providers of the service. What the service does well: What has improved since the last inspection? Staff have undertaken food hygiene training, which was a requirement at the last inspection, to protect residents from potential infection. Complaints to the home are being dealt with in a timely manner to reassure residents that their concerns are taken seriously. New bins have been provide for incontinence pads and these are now stored away from residents bathrooms, making a more pleasant environment. Culworth House Nursing Home Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Culworth House Nursing Home Version 1.10 Page 7 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 Standards Statutory Requirements Identified During the Inspection Culworth House Nursing Home Version 1.10 Page 8 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 standard(s) 1, 2, 3,and 4 Information is available to enable prospective residents to make an informed choice concerning moving into the home. EVIDENCE: A Statement of Purpose is available with required information. A notice offering a copy of this document was available within the home. A comprehensive preadmission assessment was available for new admissions to the home on which to base their care. Copies of contracts and terms and conditions were seen on the residence files checked. One resident’s file demonstrated that her daughter had been involved in her assessment and care planning process, but there was no evidence of this in the other file checked. This was made the subject of a recommendation. Culworth House Nursing Home Version 1.10 Page 9 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 standard(s) 7, 8, and10 Resident’s plans to not always reflect their needs, but residents are treated with dignity and respect. EVIDENCE: Two residents were chosen to case track on this occasion. There was evidence that both of the residents had mental health problems, but neither of them had care plans to guide staff concerning their mental health needs. This is particularly important where staff do not have the training to meet this category of care as the home is not registered for this. One of the residents had been assessed as being at high risk of developing pressure ulcers, but there was no record of pressure relieving devices being in place nor had a care plan been formulated. The night care record for one resident showed that she had not had her incontinence pad changed during the night and she was recorded as being asleep. This resident was also at high risk of developing pressure ulcers and was on a specialist mattress and should have been turned regularly throughout the night. Requirements were made in this respect. Both of these residents stated that they were well cared for within the home and appeared well groomed. Both ladies were enjoying lunch, which looked and smelled appetising. One lady particularly stated that she was enjoying her Culworth House Nursing Home Version 1.10 Page 10 lunch, as she had been unable to eat for the last two days following a recent stomach upset. She had chosen to stay in bed for the morning but was planning to get up after lunch. Staff were observed to be speaking to residents in a respectful manner and not before entering personal rooms. Culworth House Nursing Home Version 1.10 Page 11 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 standard(s) 12, 13, 14 and 15 Social activities and meals are both well-managed, creative and provide daily variation and interest for people living in the home. Visitors are welcome at any time and residents are encouraged to maintain choice and control over their lives. EVIDENCE: An activities coordinator is employed for 18 hours a week. A group of residents were involved in completing a crossword in the morning and then a gentleman arrived to conduct a Bible reading session. The activities coordinator ensured that residents were aware that this activity was going to take place and they were given the choice as to whether or not they stayed for this session. Residents spoken to stated that they were interested in reading and watching television, and one gentleman stated that he preferred his own company. Several lounge areas are available in order to facilitate this choice. One lady was pleased to report that a relative had been to visit her from Birmingham and that she had enjoyed the surprise that morning. One of the Ladies case tracked stated that her husband visits most days and that she goes out with him when she feels well enough. All of the residents spoken to a complimentary about the food provided within the home and stated that it was served in good quantities. Meals are served in the pleasant dining room or in individual rooms according to resident’s wishes. Culworth House Nursing Home Version 1.10 Page 12 A set meal is provided at lunchtime although alternatives will be provided if the resident does not like what is on offer. Different options are available at breakfast and teatime. Culworth House Nursing Home Version 1.10 Page 13 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 standard(s) 16 A robust complaints procedure is in place to reassure residents that their complaints will be acted upon. EVIDENCE: A copy of the complaints procedure was seen on the notice board in the main corridor of the home. Records of a complaint received within the home were seen and had been dealt with in a satisfactory manner. Culworth House Nursing Home Version 1.10 Page 14 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 standard(s) 19, 20, 22, 23, 24, 25 and 26. Residents live in homely surroundings, which are clean and well maintained, and suited to individual needs. EVIDENCE: A limited tour of the environment was undertaken. This demonstrated that communal areas of the home were decorated and maintained to a good standard. Extensive grounds are available for resident use in good weather. A variety of lounge areas including a large conservatory are available, as well as a pleasant dining room. Service user rooms seen showed evidence of personalisation. Small items of furniture, pictures and ornaments were on display. The home was clean, bright and airy. Problems with the lift are ongoing but the response time from the engineer was reported as being quick. The company continue to make efforts to find a replacement lift, which will fit into this listed building. Two hoists are available, one of which is currently out of service are waiting a new battery charger. Specialist mattresses, hand rails and mobility aids are available for those residents who need this equipment. Culworth House Nursing Home Version 1.10 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 Staff are working excessive hours in order to provide sufficient cover for the home. This places both residents and staff at risk. EVIDENCE: The pre- inspection questionnaire completed by the company states that staffing is provided according to the staffing notice issued by the Health Authority prior to the Commission for Social Care Inspection. In order to provide this cover a total of 672 hours of staff are needed per week. According to the staff list provided the number of contracted hours is 427.5 hours per week excluding the manager who should be supernumerary. On average only eight hours a week are provided by agency staff, leaving a shortfall of 194.5 hours to be covered by extra hours worked by contracted staff. Staff rotas provided, demonstrate that some staff work in excess of 132 hours per fortnight, leading to them becoming overtired and therefore putting residents at risk. Staff spoken to stated that they did not all work these hours from choice but that it was a necessity in order to cover the home. There is no allowance in the contracted hours to cover for holidays, sickness or staff training. In addition to providing care, care staff are required to undertake the laundry within the home and do not always have time to complete the ironing. The staffing notice covers staff required for care duties only and not for domestic or laundry duties and additional hours must be provided to cover these tasks. Comment cards received from residents highlighted issues with a shortage of staff and also problems with the laundry. Culworth House Nursing Home Version 1.10 Page 16 Requirements concerning staffing have been made. Care staff spoken to confirmed that they had received a three day induction programme on commencement of employment and had also received in-house training for moving and handling and health and safety. The company has its own training department and the pre-inspection questionnaire states that 75 of staff are qualified to National Vocational Qualification level 2 or above. Culworth House Nursing Home Version 1.10 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33 and 38 There is no stable management structure within the home to supervise staff and to give residents confidence that their needs will be met. EVIDENCE: The home has had a total of six acting managers since the formation of the National Care Standards Commission in April 2002. This has created a very unstable situation within the home with no permanent leader to organise the management and care provided. The acting managers are supported by monthly visits from the regional manager of the company and also by phone to head office. The current acting manager is the first level registered nurse, who has been in post for four months and who has no previous experience of running a care home in this country, but has previously worked as a registered nurse in another home within the company. Her application to register has not yet been received by the Commission for Social Care Inspection. Linked to the low numbers of registered nurses employed within the home, the acting manager is required to work in the home as a registered nurse on duty and is Culworth House Nursing Home Version 1.10 Page 18 only given three or four shifts a month in order to manage the home. This results in her having little time to monitor the care provided or to ensure care plans are up to date and relevant to resident needs for staff guidance. Requirements concerning the staffing in the home have been made. Records of testing of fire alarms and emergency lighting were seen and found to be up-to-date. Health and safety posters were on display within the home. Moving and handling assessments were seen in the case records tracked, and staff confirmed that they had received training in this subject. All baths have thermostatic valves fitted to control the temperature of the hot water, but the hot water provided at wash hand basins in the home remains very hot. There was no evidence of risk assessments being in place for this danger. This was the subject of a requirement at the last inspection and remains outstanding. Culworth House Nursing Home Version 1.10 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 x 3 3 3 3 3 STAFFING Standard No Score 27 1 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 1 x 3 x x x x 2 Culworth House Nursing Home Version 1.10 Page 20 yes 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 7 Regulation 12(1)a Requirement Residents care plans must be reviewed to ensure that plans are in place to address all identified needs. Mental health care plans must be formulated for those residents presenting with challenging behaviour. Action must be taken to reduce the excessive hours worked by staff in the home, in order to protect both them and the residents from harm. An application to register a manager for the home must be forwarded to the Commission for Social Care Inspection. ( timescale of 1/9/04 not met. ) Hot water temperatures at all service user outlets must comply to Health and Safety guidelines to prevent the risk of scalding. (Timescale of 14/11/04 not met.) Staffing levels must be increased or separate laundry staff provided in order to meet the staffing notice in place. Timescale for action 14/7/05 2. 8 12(1)a 1/6/05 3. 27 18(1)a 14/6/05 4. 31 8(1)a 14/7/05 5. 38 13(4)a 1/7/05 6. 27 18(1)a 1/7/05 Culworth House Nursing Home Version 1.10 Page 21 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 4 24 25 Good Practice Recommendations Efforts should be made to involve residents or their advocate in initial assessments, plans of care and reviews. Evidence should be available on individual files, that residents have been offered the facility to lock their individual rooms. Residents should be able to control the heating in their individual rooms. Culworth House Nursing Home Version 1.10 Page 22 Commission for Social Care Inspection 1st Floor, Newland House Campbell Square Northampton NN1 3EB 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. Extracts may not be used or reproduced without the express permission of CSCI Culworth House Nursing Home Version 1.10 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. 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