Inspection on 22/11/05 for Culworth House Nursing Home

This inspection was carried out on 22nd November 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 12/05/05

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 Mrs Linda Preen Unannounced Inspection 22nd November 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Culworth House Nursing Home DS0000012610.V264847.R02.S.doc Version 5.0 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. Culworth House Nursing Home DS0000012610.V264847.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Culworth House Nursing Home Address Queens Street Culworth Banbury Oxfordshire OX17 2AT 08453 455744 01295 768201 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) Culworth House Partnership Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35), Physical disability (35) of places Culworth House Nursing Home DS0000012610.V264847.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th May 2005 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 DS0000012610.V264847.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One hour was spent prior to the inspection reviewing previous requirements and recommendations, and statutory notifications from the service. The inspection took place over a period of three 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 staff records and medication records were seen. A limited tour of the environment was undertaken. What the service does well: What has improved since the last inspection? What they could do better: Resident care plans remain inadequate with conflicting information and insufficient detail to allow carers to provide for their needs. Culworth House Nursing Home DS0000012610.V264847.R02.S.doc Version 5.0 Page 6 Staff continue to work excessive hours, with staff working up to 12, 12-hour shifts in a row. This could have an adverse effect on their health and also on resident care owing to staff being over tired. Hot water temperatures at hand basins are not controlled leading to a potential risk of residents and staff scalding. These were the subject of requirements at the last inspection and remain outstanding. The company have been required to address these issues. 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. Culworth House Nursing Home DS0000012610.V264847.R02.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Culworth House Nursing Home DS0000012610.V264847.R02.S.doc Version 5.0 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 the following standard(s): These standards were not assessed on this occasion. EVIDENCE: Culworth House Nursing Home DS0000012610.V264847.R02.S.doc Version 5.0 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 the following standard(s): 7, 8, 9 and 10. Resident plans do not give sufficient information to allow carers to meet their needs. Satisfactory systems are in place for the control of medication in the home. There was no evidence that resident’s privacy was respected. EVIDENCE: Two residents were chosen to case track. These records were totally inadequate to guide staff on meeting the needs of residents. In one case two sets of care plans were in use for the same resident. These two sets of records had conflicting information. For example problems reported in one set of notes were not recorded in the other. Care staff records made reference to care problems that did not appear elsewhere and medical conditions mentioned as being of concern, had no further mention, even though several months have passed since the original investigations took place. This lady is identified as being at risk of developing pressure sores. Her care plan for this problem records that she is on a pressure-relieving mattress but does not record if she has been provided with a pressure relieving cushion for use in her chair. The second resident had a care plan for elimination stating “ wears pads day and night” there is no record of the type of pads to be worn or the frequency of Culworth House Nursing Home DS0000012610.V264847.R02.S.doc Version 5.0 Page 10 change. In the Doctors visit record, it states that this gentleman could be provided with a Conveen sheath but there is no record of this anywhere else and no indication whether this had been provided or the outcome of this trial. He has a problem of “ erratic behaviour” identified on assessment on the 13th June 2005, but no description of this behaviour or care plan to guide staff on how to deal with it. His pressure ulcer risk assessment shows him to be at risk of developing pressure ulcers but there is no record of any preventative measures being in place for this problem. There was no evidence of resident or their advocate having any input in the formulation or review of these care plans. Inadequate care plans were identified as requirements at the last inspection, and there is no evidence that this problem has been addressed, other than some research material obtained by the Registered Manager in the last two weeks, which she stated she intends to utilise to assist staff in completing care plans. Requirements have again been made in this respect. The General Practitioner arrived to make his weekly round of the home during the inspection and records of his visits and their outcomes were seen in the files checked. Medication records were inspected and found to be satisfactory. Systems are in place for the ordering, recording, administration and disposal of medication in the home. There was no evidence that residents had been offered locks to their rooms or that they had lockable facilities provided for private possessions. A notice on the notice board directed them to request a lock if they wanted one, but there was no evidence that this had been drawn to their attention. The Registered manager stated that they had been asked but could provide no evidence of this. Culworth House Nursing Home DS0000012610.V264847.R02.S.doc Version 5.0 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 the following standard(s): 12, 13,14 and 15 Resident choice is considered concerning their daily life and visitors. The standard of food is good. EVIDENCE: An activities co-ordinator is employed three days a week. Evidence of craftwork produced by the residents was seen in the home. An activities programme was on display on the notice board. The registered manager reported that a summer fete had been very successful and that a Christmas party for residents and their families was planned for late December. Relatives were present at the time of the inspection and one lady goes out every day with her husband. Residents were sitting in the various lounge areas or in their rooms according to personal choice. Lunch was served either in their rooms or in the pleasant dining room. A group of residents awaiting lunch in the dining room were unaware of what was on the menu. They confirmed that the standard of food was good, but they stated that they just had what was brought and that no choice was offered. A discussion took place with the cook who stated that a choice was always available. When questioned, she confirmed that residents were not offered a choice before the meal, but if they said they didn’t like what was offered, an Culworth House Nursing Home DS0000012610.V264847.R02.S.doc Version 5.0 Page 12 alternative would be provided. She also stated that weekly menus were available for resident reference. A recommendation was made in this respect. Culworth House Nursing Home DS0000012610.V264847.R02.S.doc Version 5.0 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 the following standard(s): 16 and 18 Residents may be assured that their complaints are taken seriously, and that staff training protects them from abuse. EVIDENCE: Complaints received by the Commission since the last inspection concerning care issues have been dealt with in an efficient manner. An abuse policy is available for staff guidance and staff training records demonstrate that all staff have received training in the recognition and prevention of abuse. Culworth House Nursing Home DS0000012610.V264847.R02.S.doc Version 5.0 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 the following standard(s): 19,23,24 and 25 Residents live in homely surroundings, which are well maintained and clean. EVIDENCE: A limited tour of the environment was undertaken. Some resident’s rooms, corridors and toilet facilities have been decorated since the last inspection. One of the bathrooms on the first floor was very cold and unwelcoming but the Registered Manager stated that the residents were not currently using this. Resident rooms seen showed evidence of personalisation with ornaments, pictures and small items of personal furniture on display. These rooms were bright and airy but the temperature cannot be controlled by the occupant, leading to no individual choice being available. Culworth House Nursing Home DS0000012610.V264847.R02.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Staff is provided in insufficient numbers to enable shifts to be covered without staff working excessive hours. Procedures for the recruitment of staff provide safeguards necessary to offer protection to the people living in the home. Staff are not always provided with the necessary training to do their jobs. EVIDENCE: The duty rotas are produced by head office. These contained the names of people not employed in the home. For example a laundry person was recorded as being planned to work, but this person had never commenced work in the home. This makes it difficult to ascertain that adequate staffing is being provided. The Registered Manager stated that she has only got four daytime carers to cover the shifts in the home. Staff are rostered to work excessive hours. For example, 12, 12 hour shifts in a row. Although it is acknowledged that these staff have signed an opt out clause from the European Working Time directive, these excessive hours will put a strain on the health of the carers and may have an adverse effect on residents who are being cared for by very tired staff. Staff records are not kept in the home, and information concerning recruitment practices was requested from the company office during the inspection and was provided from head office. This confirmed that Criminal Record Bureau checks and references have been obtained prior to employment in order to protect the residents from possible abuse. The staff training matrix was seen. This demonstrated that statutory training in Food Hygiene is not provided for care staff as noted at standard 15 above. A Culworth House Nursing Home DS0000012610.V264847.R02.S.doc Version 5.0 Page 16 training officer is employed by the company to provide training and updates. All staff have received health and safety training but only two have completed Infection control. Only one member of care staff has completed dementia care training, and although the home is not registered to admit residents requiring dementia care, several residents have developed dementia since admission. Culworth House Nursing Home DS0000012610.V264847.R02.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35 and 38 EVIDENCE: The acting manager has been Registered by the Commission for Social Care Inspection since the last inspection. She is a 1st level Registered Nurse who is currently studying for a management qualification. Residents and staff appeared relaxed in her presence and visitors approached her freely during the inspection. Records of resident pocket money accounts were seen and found to be satisfactory. Chiropody and hairdressing are charged direct to the relatives and not dealt with by the home. Health and safety information was on display in the home. The hot water provided to hand basins remains very hot and could cause a risk of scalding to residents. There was no evidence that risk assessments have been carried out Culworth House Nursing Home DS0000012610.V264847.R02.S.doc Version 5.0 Page 18 in this respect. This was made a requirement at the previous two inspections and remains outstanding. The care staff are responsible for the evening meal and for serving other meals. The cook leaves sandwiches ready and the care staff prepares hot snacks. None of the care staff have a food hygiene certificate, putting residents at risk from infection. This was made the subject of a requirement. Culworth House Nursing Home DS0000012610.V264847.R02.S.doc Version 5.0 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. 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 3 3 3 X STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 2 Culworth House Nursing Home DS0000012610.V264847.R02.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 12(1) a Requirement Residents care plans must be reviewed to ensure that plans are in place to address all identified needs. Previous timescale of 14/7/05 not met) Mental health care plans must be formulated for those residents presenting with challenging behaviour. (Previous timescale of 1/6/05 not met) 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. Previous timescale of 14/06/05 not met) All staff involved in the preparation and serving of food must undertake food hygiene training. Hot water temperatures at all service user outlets must comply with Health and Safety guidelines to prevent the risk of scalding. (Timescale of 14/11/04 and DS0000012610.V264847.R02.S.doc Timescale for action 01/01/06 2. OP8 12(1) a 01/01/06 3. OP27 18(1) a 01/01/06 4 OP38 13(1) 4 01/03/06 4 OP38 13(4) a 01/01/06 Culworth House Nursing Home Version 5.0 Page 21 5. OP27 18(1) a 01/07/05 not met.) Staffing levels must be increased or separate laundry staff provided in order to meet the staffing notice in place. (Previous timescale of 01/07/05 not met) 01/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4 Refer to Standard OP4 OP15 OP24 OP25 Good Practice Recommendations Efforts should be made to involve residents or their advocate in initial assessments, plans of care and reviews. Residents should be offered a choice of meals prior to they’re being served and should be aware of what is on offer so that an informed choice may be made. 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 DS0000012610.V264847.R02.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Northamptonshire Area Office 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. 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