Inspection on 29/11/05 for Cumberland Care Home

This inspection was carried out on 29th 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 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

Cumberland Care Home 01/04/09

Cumberland Care Home 07/05/08

Cumberland Care Home 29/05/07

Cumberland Care Home 11/07/06

Cumberland Care Home 25/03/05

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

CARE HOMES FOR OLDER PEOPLE Cumberland Care Home, The 67 Whitford Gardens Mitcham Surrey CR4 4AA Lead Inspector Liz O`Reilly Unannounced Inspection 29th 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 Cumberland Care Home, The DS0000061986.V272329.R01.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. Cumberland Care Home, The DS0000061986.V272329.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Cumberland Care Home, The Address 67 Whitford Gardens Mitcham Surrey CR4 4AA 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) 0208 646 1551 0208 646 5283 Care UK Community Partnerships Limited Mr Minkailu Sama Care Home 48 Category(ies) of Dementia - over 65 years of age (48) registration, with number of places Cumberland Care Home, The DS0000061986.V272329.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th June 2005 Brief Description of the Service: The Cumberland Care Home is a purpose built facility situated in residential area of Mitcham. The property is detached and single storey with parking available on site. Public transport facilities are close by. The home is owned and managed by Care UK Community Partnerships Ltd, a subsidiary of Care UK plc. Care UK is a private company who own and manage a significant number of homes throughout the country. The home provides long term and respite nursing care and accommodation for up to 48 older people with dementia. Cumberland Care Home, The DS0000061986.V272329.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by two regulation inspectors over six hours on 29th November 2005. The inspectors had the opportunity to speak with residents staff and the registered manager of the home. The home is divided into two units. This inspection focused on Lowrey/Turner unit. What the service does well: What has improved since the last inspection? What they could do better: Work needs to focus on developing staff skills in communicating effectively with residents and respecting dignity by making sure that care is taken over the appearance of individuals. Staff must provide drinks to residents on request. Work on staff training needs to be continued to ensure that all staff have been provided with training and if necessary updates on dementia care. To ensure Cumberland Care Home, The DS0000061986.V272329.R01.S.doc Version 5.0 Page 6 the safety of residents all staff working in the home need to be provided with training on the protection of vulnerable adults. Staff must ensure that residents and if appropriate their representatives are consulted on and agree care plans. Care plans need to include how the cultural and or religious needs of residents will be met. Wound care records need to be improved. The work commenced on replacing fixtures in en suite bathrooms needs to be continued. Staff need to ensure that any spillages on carpets are cleaned up without delay. 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. Cumberland Care Home, The DS0000061986.V272329.R01.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 Cumberland Care Home, The DS0000061986.V272329.R01.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): 1&3 Residents are provided with good information on the home. Changes will need to be made to the Statement of Purpose and Service User Guide to include recent changes to the homes’ registration. Care is taken to make sure that staff are aware of and can meet the needs of new residents. EVIDENCE: The home is now providing care for a number of residents with mental health needs other than dementia. This change will need to be reflected in the information available to prospective and present residents. A number of residents were in the process of moving into the home from hospital. Care was seen to have been taken to make the transition as smooth as possible for these residents. Assessments of individual needs were completed and staff from the hospital were working in the home for a period following the transfer. The assessments and support of hospital staff assist in Cumberland Care Home, The DS0000061986.V272329.R01.S.doc Version 5.0 Page 9 making sure that staff in the home have a clear understanding of the needs of each resident. Cumberland Care Home, The DS0000061986.V272329.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Improvements continue to be made in the care planning. Staff must make sure that care plans and any changes are agreed by the resident and their representatives. The records of medication have improved. Further work needs to be done to make sure a clear record of wound care is kept. All staff must be provided with clear guidance on how to respect the privacy and dignity of residents at all times. Senior staff must challenge any instances where inappropriate comments are made by staff. The manager must ensure that staff take more care about the personal appearance of residents. EVIDENCE: Staff have access to good information on the individual interests, lifestyle of residents along with their personal physical needs. Care plans are reviewed regularly. The home is in the process of setting up a computerised system for records which includes the care plan for each person. Staff must ensure that residents and if appropriate their representatives are consulted and that care plans along with any changes are agreed. Staff must Cumberland Care Home, The DS0000061986.V272329.R01.S.doc Version 5.0 Page 11 also make sure that information on how the religious and or cultural needs of individual residents will be met. It was noted that staff had consulted with relatives over the use of reclining chairs. Where reclining chairs are used for residents who are unable to adjust them themselves clear information must be included in the care plan as to the reason for their use. All residents are registered with a local GP and arrangements are made for regular dental, optical and chiropody services. The wound care records need to be more detailed with clear information on the treatment for any wound. Staff must carry out and record an assessment of each wound each time the dressing is changed. This assessment must include the size and condition of the wound. The recording of medication has improved. Records of the administration, receipt and retuned medication were well maintained. Generally staff were observed to approach residents in an appropriate manner. However one member of staff was overheard making comments to a resident that they did not have time to work at the residents own pace. This manner of rushing residents to meet staff timescales is not respectful, does not meet the needs of the individual and the fact that these comments were made in the main corridor does not respect the privacy of the individual. Senior staff were in the area when these comments were made and did not challenge the member of staff concerned. The manager must ensure that all staff are provided with clear guidance on respecting residents dignity and privacy and working at the pace of each individual. Senior staff must be reminded of their duty to challenge any poor practice they may see or hear. Should staff have insufficient time to work at the residents pace then the organisation must take action to provide additional staffing hours. This issue was discussed at the time of this visit with the manager. The appearance of a number of residents indicated a lack of care being given to personal appearance. Residents were seen to be wearing clothing that did not fit properly, a significant number of colours and odd socks. The hair of a number of residents did not appear to have been attended to. The manager must ensure that where residents need assistance with personal grooming including choosing clothing staff take care to respect the dignity of individuals. Should residents have insufficient clothing the manager must make arrangements for new clothing to be provided. Cumberland Care Home, The DS0000061986.V272329.R01.S.doc Version 5.0 Page 12 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, 14 & 15 The home has a good structured activities programme. Further work needs to be done with staff on supporting residents to make informed choices in their day to day lives. Residents made positive comments on the food provided. Staff must ensure that drinks are available at all times and must be provided on request. Staff must be reminded of the importance of communication in engaging residents. EVIDENCE: Residents are provided with a good structured activities programme. Weekly activities include arts and crafts, games, reminiscence, music sessions, working in the garden and domestic skills. Activities are carried out in small groups on a one to one basis. The home benefits from a Snoezelen Room which provides space for residents to relax with visual, auditory or sensory stimulation. The activities organiser provides weekly opportunities for residents to take part in structured sessions which focus on communication. The inspectors found evidence of good communication between staff and residents. Staff were seen to talk with residents in a positive manner and engage the interest of individuals. However this was not consistent throughout the staff group. During time spent in one of the lounges the inspectors noted Cumberland Care Home, The DS0000061986.V272329.R01.S.doc Version 5.0 Page 13 instances of poor communication. One resident was seen to get up from their chair on numerous occasions. Each time this resident was told to “sit down”. Staff did not approach this person to find out if they wanted anything or were uncomfortable in any way. No conversation was struck up between staff and any of the residents in the room. Residents were not engaged in any activity at all. Staff must be provided with clear guidance on the importance of good communication in engaging and stimulating residents. Small napkins have been provided to residents as alternative to bibs. A record of the preferences of residents on this issue was seen to be kept. Staff must continue to take care to use bibs only at a residents request or where changing clothing causes distress. The majority of residents who were able to make a comment felt the food was good and that they had sufficient to eat. The inspectors observed one resident request a drink to be told by staff that they would be getting a cup of tea soon. This comment was made fifteen to twenty minutes before the set time for all residents to be provided with a cup of tea in the afternoon. No drinks were seen to be available in the lounge areas on this unit. The manager must ensure that residents are offered drinks on a regular basis and that staff provide drinks when requested to do so by residents. Staff must ensure that residents are provided with clear opportunities to make their own informed choices in day to day issues. Cumberland Care Home, The DS0000061986.V272329.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 A clear complaints procedure is in place. All staff must be made aware of the procedure. The manager must ensure that all complaints are investigated. All staff must be provided with training on the protection of vulnerable adults. EVIDENCE: The complaints record includes details of complaints made, the investigation and outcomes. The manager must ensure that all complaints are recorded and investigated. The minutes of the relatives meeting held on 10th November 2005 record that the suggestion box in the home has been used for anonymous complaints which cannot be followed up. Staff from the home also advised relatives at this meeting that complaints could be taken to the CSCI if they were not happy with the outcome of an investigation and a discussion with the manager. Staff must be reminded that a complaint can be addressed to the CSCI at any time should residents or relatives feel unable to approach the home. Systems are in place for the recording of any suspicion or allegation of abuse. Senior staff in the home are aware of their responsibilities to report any suspicion or allegation to the appropriate authorities. Not all staff have been provided with training on the protection of vulnerable adults. It is important that all staff are aware of the forms abuse may take and what action they need to take should they have any concerns. Cumberland Care Home, The DS0000061986.V272329.R01.S.doc Version 5.0 Page 15 Cumberland Care Home, The DS0000061986.V272329.R01.S.doc Version 5.0 Page 16 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, 20 & 26 Work needs to continue to provide a satisfactory environment for residents. The majority of the home was found to be clean and tidy. Further attention needs to be focused on the regular cleaning of carpets. EVIDENCE: Each unit has two lounge areas and one dining room. The record of the recent relatives meeting stated that relatives were informed by staff that certain lounges were not supplied with a television as the CSCI required there to be a quiet lounge. The manager should note that there is no requirement for a quiet lounge to be available. The provision of a quiet lounge is a decision for the home to make. Several bedrooms were seen to have been personalised with items that show the individual likes and interests of residents and provide a more homely environment. Cumberland Care Home, The DS0000061986.V272329.R01.S.doc Version 5.0 Page 17 New carpeting has been provided in some of the bedrooms. A number of en suite bathrooms had been furnished with new cabinets, shower rails and toilet roll holders. This work needs to be continued to ensure that all damaged equipment is replaced. A number of bathrooms have rusted and cracked shower drainage outlets. These need to be repaired or replaced. Ten bedrooms have stained carpets and in two bedrooms there was a strong odour. The chest of drawers in two bedrooms were broken and in two bedrooms the curtains were not long enough for the windows. All curtains in the home need to be checked and new curtains provided where they do not fit the windows. The work started on improving the environment needs to be continued. Particular attention must be paid to keeping carpets in good condition. All staff should be reminded to take action to mop up spills as soon as possible. The laundry area was seen to be well managed with separate entrance for soiled laundry and exit for clean linen. Appropriate laundry equipment is in place to deal with the volume and type of work. Cumberland Care Home, The DS0000061986.V272329.R01.S.doc Version 5.0 Page 18 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, 29 & 30 Sufficient staff were seen to be available to meet the needs of the residents in the home at the time of this visit. Staff are provided with good opportunities for training. This helps in making sure that residents are cared for by a well informed staff group. Specific training on dementia care is in progress and needs to be continued. Residents are protected by the checks carried out on staff before they start working in the home. EVIDENCE: A minimum of one qualified nurse and four carers are available on each unit. Agency staff are not being used which makes sure that residents receive continuity of care. The home has a full time activities organiser with separate catering domestic and administrative staff employed. Good systems were seen to be in place to allocate work tasks and to provide care for individual residents. The training record for three staff were examined. Staff had been provided with training on a range of issues including first aid, health and safety, wound management, dealing with challenging behaviour, moving and handling and continence. One of the three staff had completed an eight week course on dementia in 2002. None of the staff training records seen included the protection of vulnerable adults and one registered general nurse had no record of training on dementia. These issues need to be addressed. Plans must be Cumberland Care Home, The DS0000061986.V272329.R01.S.doc Version 5.0 Page 19 made for all staff to receive training, at a level appropriate to their position in the home, on dementia care. Regular updates need to be provided for those staff who have received this training in the past. A copy of the training programme should be supplied to the CSCI. The home carries out checks, including seeking references and Criminal Records Bureau checks on all staff before they start working in the home. These procedures assist in ensuring the safety of residents. Cumberland Care Home, The DS0000061986.V272329.R01.S.doc Version 5.0 Page 20 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 & 38 The manager holds appropriate qualifications for the post. Staff carry out regular checks to ensure the health, safety and welfare of residents, staff and visitors to the home. EVIDENCE: The registered manager is a qualified nurse and has managed the home for six years. The manager takes up opportunities for training to ensure that his knowledge is up to date. Staff carry out regular checks on the building and equipment to ensure the health and safety of residents. The records of fire alarm, hot water, hoists, emergency lighting and general monthly checks were seen to be well maintained. Cumberland Care Home, The DS0000061986.V272329.R01.S.doc Version 5.0 Page 21 The home keeps a record of any accident in the home which includes a description of the incident, actions taken and outcomes. The inspectors discussed the use of lap belts when moving residents in a wheelchair. The inspectors would not view the use of lap belts when transporting residents in a wheelchair from one part of the home to another as restraint. The use of these belts and foot plates are important to ensure the safety of residents. Where a resident uses a wheelchair permanently then discussion must take place with the resident and or their representatives on the use of lap belts. Cumberland Care Home, The DS0000061986.V272329.R01.S.doc Version 5.0 Page 22 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 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 3 x x x 3 x 2 STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x x x x 3 Cumberland Care Home, The DS0000061986.V272329.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1)(2) 12(2) Requirement The Registered Persons must ensure that care plans are compiled in consultation with residents and if appropriate their representatives. The Registered Persons must ensure that a clear record of wound care is maintained. The Registered Persons must ensure that staff are provided with clear guidance on respecting the privacy and dignity of residents at all times. The Registered Persons must ensure that details of how the cultural and or religious needs of individual residents will be met. The Registered Persons must ensure that residents are supported to make their own informed choices in their day to day lives. The Registered Persons must ensure that residents are supplied with drinks on request. The Registered Persons must ensure that all staff working in the home are provided with training on the protection of DS0000061986.V272329.R01.S.doc Timescale for action 01/04/06 2. 3. OP8 OP10 17(1)(a) sch 3(k) 12(4) 20/01/06 20/01/06 4. OP7 12(4) 20/02/06 5. OP14 12(2)(3) 20/02/06 6. 7 OP15 OP18 16(2)(i) 13 20/01/06 01/04/06 Cumberland Care Home, The Version 5.0 Page 24 8 OP26 16(2)(k) 23(2)(d) 9 OP30 18(1)(c) vulnerable adults. The Registered Persons must take action either through regular additional cleaning and or the replacement of carpeting to ensure that the home is free from offensive odours. The Registered Persons must ensure that all staff are provided with training, to a level appropriate to their position in the home, on dementia care. Regular updates must be provided for staff who have received this training in the past. 01/04/06 01/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cumberland Care Home, The DS0000061986.V272329.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 Cumberland Care Home, The DS0000061986.V272329.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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