Inspection on 07/05/08 for Cumberland Care Home

This inspection was carried out on 7th May 2008.

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

Cumberland Care Home 01/04/09

Cumberland Care Home 29/05/07

Cumberland Care Home 11/07/06

Cumberland Care Home 29/11/05

Cumberland Care Home 25/03/05

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Cumberland Care Home 67 Whitford Gardens Mitcham Surrey CR4 4AA Lead Inspector Liz O`Reilly Unannounced Inspection 7th May 2008 10:25 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 DS0000061986.V363269.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. Cumberland Care Home DS0000061986.V363269.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cumberland Care Home 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 manager.cumberland@careuk.com www.careuk.com Care UK Community Partnerships Ltd Minkailu Sama Care Home 48 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (48), Mental disorder, excluding learning of places disability or dementia (1), Mental Disorder, excluding learning disability or dementia - over 65 years of age (6) Cumberland Care Home DS0000061986.V363269.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION conditions of registration: 1. As agreed on the 17/10/2006, two Service users under the age of 65 with Dementia can be accommodated within the home. 29th May 2007 Date of last inspection 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 56 older people with dementia. Fees for this home range from £651.00 to £800.00. Cumberland Care Home DS0000061986.V363269.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means people who use this service experience adequate quality outcomes. Since this inspection visit the registration of the home has been altered and the number of people who the service provides nursing care for has been increased to 56. This unannounced inspection was carried out by two regulation inspectors on the first visit and one inspector made a second visit for half a day. One inspector used the Short Observational Framework for Inspection (SOFI). This involves an observation of the activity taking place for a small number of people with dementia in a communal area. We spoke to ten people who use the service, five staff, the manager, the regional manager and three visitors to the service. We received six surveys from relatives of people who use the service and five surveys from staff. What the service does well: We found generally there were high levels of interaction between staff and people who use the service. Staff have received training in Activities Based Care and we found this had produced a real improvement in the way in which staff across the service, including domestic staff, were communicating with individuals. We observed lots of touch, humour and chatting. People who use the service are provided with a good environment with lots of opportunities for activities. The lounges contain arts and craft equipment, soft toys, tactile objects, dolls and hats. The corridors have tactile panels, washing lines, spectacles and memory boxes. People who use the service gave us some very positive comments about particular staff saying, “she is lovely”, “I like her” and “he’s a good one”. Visitors told us there had been “a vast improvement” and that the service had “much improved over the last year”. Both of these visitors felt that people were being offered better one to one stimulation than they had been. One person told us they had “confidence” in the staff and felt they could “trust the staff to look after” their relative. Cumberland Care Home DS0000061986.V363269.R01.S.doc Version 5.2 Page 6 Staff were found to be enthusiastic about putting their training into practice. They felt that improvements had been made and had their own good ideas about how more improvements could be made. What has improved since the last inspection? What they could do better: It is of concern that the recording of wound care and medication was not up to date or accurate. Overall there has been a lack of monitoring to ensure that staff are following action plans, policies, procedures and good practice. Communication systems between other health care professionals and staff were not working well. This puts at risk the health and welfare of people who use the service. During the course of this inspection action was taken to make sure that in future recording, communication and monitoring is improved. One person in a survey told us that they had witnessed, on occasion, some staff lose their temper when dealing with a difficult situation. Although they felt this was not “the norm” this must be addressed with the staff group. Staff must be provided with the instruction, guidance and support to ensure that Cumberland Care Home DS0000061986.V363269.R01.S.doc Version 5.2 Page 7 they are able to deal with difficult situations, both individually and as a group, without exhibiting abusive behaviour. Where risk assessments show a high risk, for example in relation to nutrition staff must make and record what actions they have taken. When asked what they felt could be improved staff told us that mealtimes could be better. We observed mealtimes in both units and agree that this is an area where improvements could be made. We have made a number of recommendations which may assist in making mealtimes a more social event. When relatives were asked what they thought could be improved all those who responded felt the garden and outdoor access was lacking. At the time of this visit people were using the garden but we are aware that this has not always been open to people who use the service. We have recommended the provision of more outdoor covered areas. We observed that those people who are more withdrawn or have more difficulty in communicating did not have as frequent interactions with staff. Staff need to be made aware of this and look at ensuring each person is acknowledged regularly, however briefly. We also observed two instances where staff responded to people asking to go home or wanting their mum in totally different ways within a very short time. This needs to be discussed so that staff can have a consistent response and for staff to gain a better understanding of what these type of questions might mean to the person. 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. Cumberland Care Home DS0000061986.V363269.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 Cumberland Care Home DS0000061986.V363269.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): 1&3 People who use this service receive experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People who use this service are provided with good information on what they can expect when they move into the home. Assessments are completed before people move in and these are kept under review. EVIDENCE: Pre admission assessments are carried out to make sure that the service can meet the needs of the individual. This information also gives staff some knowledge of individual needs before they move in so that an initial care plan can be in place from day one. Information on what people can expect from the service is provided in the Service User Guide. This is provided within a ‘welcome’ pack which is given to each person when they move into the home and available to prospective residents. Documents are also available in large print. The manager informed Cumberland Care Home DS0000061986.V363269.R01.S.doc Version 5.2 Page 10 us that information can be translated for people who’s first language is not English. It is suggested that the views of people who use the service, from quality monitoring surveys, are included in the welcome pack. This will allow prospective residents to see what people living at the home feel about the support they receive. The addition of photographs of the home, staff and activities may provide people who are living with dementia with more information on the service. Discussions with staff showed that they understand the importance of spending time with people when they first move in. Cumberland Care Home DS0000061986.V363269.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): 7, 8, 9 & 10 People who use this service experience adequate quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Improvements have been made in working towards a more person centred care plan and in providing more person centred care. However care plans in relation to wound care were not accurate and did not provide up to date information. The management of medication was poor and there has been a lack of monitoring from senior staff. Action plans put in place during this inspection should produce improvements in these areas. EVIDENCE: The relatives of people who use the service told us that “staff monitor the medical needs” of their relatives and “I am kept up to date with any changes or medical problems”. We observed staff talking with people and supporting them in a manner which protected their privacy and dignity. Staff expressed a good knowledge of the importance of treating people with respect and supporting them to retain as much independence as possible. Our observations indicated a real Cumberland Care Home DS0000061986.V363269.R01.S.doc Version 5.2 Page 12 improvement in the manner in which certain staff are working with people. This needs to be carried forward across the whole staff group. We saw that people were well dressed and had made their own choices about the way their hair was dressed and coloured. We looked at care planning for five people using the service at the first visit to the home. We found improvements in the care planning with more information on the social needs and wishes of individuals. We found staff were including some of the strengths of people who use the service as well as their needs. Staff have included information on some of the cultural needs of individuals but this could be expanded to include personal care needs and wishes. We found little evidence that people who use the service and or their representatives have been involved in the care planning process. Despite previous action plans produced by the manager following complaints, the care planning in relation to wound care had not improved. In one instance we found instructions provided by the tissue viability nurse recorded in April of this year but not acted upon. We were later informed that the information recorded was not accurate however staff spoken to were not aware either of the information recorded or of its’ accuracy. The care plan for this person had not been updated since November 2007. The assessments of wounds, which should be carried out at each dressing change, were not of a good standard. The nutritional assessment carried out by staff indicated this person was at high risk however we could find no evidence that any action had been taken to obtain advice from a dietician until this was requested by the tissue viability nurse. The action plan from the manager following complaints included information that staff were now using a particular nutritional assessment. We were informed by staff in one unit that they were not using this assessment. The action plan also stated that a link nurse for tissue viability or wound care had been allocated in the home. Senior staff we spoke to were not aware of this. We were informed by staff that they were not carrying out pain assessments. As research has highlighted significant levels of untreated pain in homes for people with dementia this lack of assessment needs to be reviewed. The lack of good communication, care planning, assessment and lack of continuity when new instructions were received from other health care professionals put at risk the health and welfare of people who use this service. At the second visit to the service we saw significant improvements in the care planning for wound and pressure area care. These plans provided good information on any wound and the treatment required. Plans were in place for staff to receive additional training. A clear procedure has been implemented to Cumberland Care Home DS0000061986.V363269.R01.S.doc Version 5.2 Page 13 ensure that any instructions from other professionals are communicated to all staff and care plans are reviewed. However staff had still not recorded information on when they had done dressing, what they had done and the condition of the wound. We looked at the medication and medication records on one of the two units in the service on the first day of this inspection. We found at 2pm three people had not received their medication for that morning. Medication administration sheets were not up to date or accurate. We found nineteen incidents where staff had not signed the administration sheet after giving medication. We found one incident of medication signed for as given but the medicine was still in the medication trolley. Three instances were found where quantities in medication did not tally with the record. This suggested that medication had not been given as prescribed. At the second visit to the service an action plan had been implemented. This included closer monitoring of medication, refresher training for staff and a full audit of medication was carried out. Risk assessments are in place but mainly focus on keeping people safe rather than promoting more independence. At the time of the last inspection a requirement was made that where restrictions were placed on anyone’s freedom of movement a risk assessment must be carried out in consultation with other professionals the individual concerned and or their representative. Where limitations have been placed on individual freedom of movement such as leaving the service, information on how this decision was reached and who was consulted needs to be in place. This is to protect the rights of people who use the service. This has not been carried out. Cumberland Care Home DS0000061986.V363269.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People using the service are given the opportunity to take part in a variety of activities. Real improvements have been made in the environment and the involvement of staff in supporting people to take part in daily living activities. Care is taken to support people who use the service to make choices in their day to day activities. Food is of a good quality and some improvements have been made in making mealtimes a more social event. This is an area which should be further developed. EVIDENCE: The service employs a full time activities officer who, at the time of the last inspection, was providing a very good variety of activities. Staff have taken part in Activities Based Care training and we observed that a significant number of staff were using the knowledge and skills they gained from this in Cumberland Care Home DS0000061986.V363269.R01.S.doc Version 5.2 Page 15 the type and manner of support they were providing. We saw staff talking with people who use the service and joining them in activities including supporting people to carry out their own daily living tasks, collecting their laundry and getting their own drinks. We spoke to two of the support staff who we found to be enthusiastic about putting the training they received into practice and expanding opportunities for people who use the service. The improvement in the attitude and approach of a number of staff was striking. These improvements should be continued across the whole staff group. During observations in the lounge on one unit it became apparent that staff spent less time with those people who use the service who are less able to communicate or mobilise. This is something which should be considered and addressed by staff. We are aware that staff are working with people, particularly those who are not able to get up, using a variety of sensory aids. This offers people one to one attention and stimulation. At previous inspections we have noted that the garden was not in use. At this inspection people were using the garden area and staff were planning to improve the outdoor areas with the provision of a ‘sensory’ garden. When we asked through surveys how the service could be improved relatives told us; they were “disappointed the garden is always closed even in the warmest of weather”, that people would like to “spend more time outdoors”, one improvement suggested was, “an outdoor covered area” and another person told us it would be nice to see people being “taken out for walks”. Staff have made improvements in the social information available on care plans but this could still be more detailed and needs to be focused on individual preferences. One relative told us that their relation liked music but it was “never on when I visit”. Lounge areas have a number of boxes with tactile items, prompts for staff and visitors and activity equipment. We observed people who use the service using these on a number of occasions throughout the inspection. Overall relatives we spoke to felt they were kept in touch with what was happening and that staff were approachable. We observed mealtimes in both units. We saw examples of good practice particularly around people being offered real choices. The menu is displayed on each table with pictures of each meal on offer. Staff also brought round to Cumberland Care Home DS0000061986.V363269.R01.S.doc Version 5.2 Page 16 each table a plate of each choice so that people could see the actual meal before making their choices. Staff were seen to encourage people to help themselves in a limited way such as pouring their own drinks. On one unit staff did not offer people a choice of a napkin or bib. The use of blue plastic aprons by staff at mealtimes does not contribute to a social atmosphere. Staff supported people who need help with eating in a sensitive and discreet manner. However there were times during the meal in each unit where staff became focused on getting people to sit down and to eat or drink more in a very repetitive manner. Consideration should be given to using moulds for people who need a pureed diet. This would provide a better presented meal. Staff should ensure that people are offered condiments with their meals. Consideration should also be given to providing more food around the home for those people who use the service who find it difficult to go through a whole mealtime sitting at a table. Where staff were sitting with people at tables to support them with eating we saw good interactions. In order to make mealtimes a more social event consideration should be given to protected mealtimes. This would free all staff in the home and families or friends to join with people who use the service in taking a meal. This could offer opportunities for people who use the service to help themselves if food was presented in dishes on the tables as opposed to being plated up by staff. This would also allow for more social interaction. One care plan stated that the menu includes a choice of Caribbean food. We found no evidence of this and staff told us this was not available Cumberland Care Home DS0000061986.V363269.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use this service experience adequate quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Concerns about the care provided are listened to. Care needs to be taken to make sure that any actions planned in response a complaint is carried out. The home understands the procedures for safeguarding adults and trains staff in how to do this. The way in which staff respond to situations they find difficult needs to be reviewed. EVIDENCE: The organisation has a clear complaints procedure with set timescales for responding to any complaint or concern. People who use the service and their representatives are provided with information on the complaints process in the ‘welcome pack’ when they move into the home. Information on the complaints procedure was available on display in the building. Everyone who responded to surveys we sent out told us they knew how to make a complaint. As noted previously in this report the service has responded to complaints but the action plan provided following two complaints last year was not being followed. Management and senior staff need to take care that any agreed actions are followed through. This will assist in ensuring that any omissions do not occur again and will show that the service learns from complaints or concerns raised. Cumberland Care Home DS0000061986.V363269.R01.S.doc Version 5.2 Page 18 We discussed safeguarding people who use the service with staff. We found staff had a good understanding of their responsibilities to report any allegations or suspicions of abuse. Staff knew who to report to and that the company has a ‘Whistleblowing’ procedure which will protect them should they have any concerns about other members of staff. One person told us through a survey, “I have occasionally seen staff get angry with a difficult resident but I think this is the exception not the rule”. This needs to be addressed by the management. Staff must be provided with clear guidance on how to deal with situations they might find difficult. Individualised care plans should provide staff with information on possible triggers and tactics to use when supporting individuals. How staff are supported by their colleagues, senior staff and the organisation, to deal with their own feelings when supporting people should be reviewed. Consideration should be given to providing information to visitors on what they should expect from staff and what to do if individual staff do not live up to these expectations. Cumberland Care Home DS0000061986.V363269.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 & 26 People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People living at the home enjoy a comfortable and safe living environment. Real improvements have been made to make the environment more stimulating for people living with dementia. EVIDENCE: Since the last inspection an extension has been added to the home which increases the number of rooms available. This work has been carried out to a high standard and has enhanced the indoor accommodation by providing a circular corridor for people to walk through. The décor has been made more stimulating by the addition of tactile sections, washing lines, rows of spectacles and items of interest. Outside each bedroom a ‘memory box’ has been added. This can be filled by people who use the service or their representatives with Cumberland Care Home DS0000061986.V363269.R01.S.doc Version 5.2 Page 20 items of particular interest to them and can be changed to maintain some variety. At the time of this inspection staff were planning to plant out a newly created area with plants to provide a sensory garden. As noted previously people were using the garden on the day of our visit but relatives did feel the garden was generally underused. Consideration should be given to providing a covered area and or sheds with equipment for people who use the service to sit or carry out some gardening, domestic, DIY or woodworking tasks. A new fire alarm system and call bell system has been installed. New flooring has been laid in the corridors. We found the home to be clean, fresh and well maintained. Cumberland Care Home DS0000061986.V363269.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Staff are provided with good opportunities for training. In order to safeguard people who use the service appropriate checks are carried out on staff before they start working in the home. EVIDENCE: Comments received from relatives and people who use the service about the staff included; “staff give real care and attention” to people, “I am quite please with the way they look after my relative”, “they keep me well informed of any changes”, “I like the girls here”, “these staff are very good, they look after me” and “I trust them”. One person felt there could be more “one to one” attention. There are sufficient staff on duty to meet the needs of the present group of people using the service. We were informed that staffing would be increased once the new rooms were occupied. One additional night support worker will be employed and an additional support worker will be employed to cover the busier times during the day. Cumberland Care Home DS0000061986.V363269.R01.S.doc Version 5.2 Page 22 We found appropriate checks are carried out on staff before they start working in the home, including Criminal Records Bureau checks and references. This assists in safeguarding the people who use the service. Staff are provided with good opportunities for training. We observed staff using the skills and knowledge gained from training in their day to day work. We saw a number of staff taking opportunities to sit with people who use the service and encourage them to be involved with daily living activities. Other staff were perhaps too focused on carrying out tasks rather than the person. We were informed that all qualified staff have been registered on a Diploma in Dementia care course which will be commencing this year. We were informed by the manager that the majority of staff have gained NVQ level two in care. Staff told us they had recently taken part in training on moving and handling, first aid, fire awareness and exploring differences. New staff take part in induction which is carried out over three to four days. After this staff follow a two week programme of training through a distance learning package supplied the organisation. Generally we found staff enthusiastic about increasing or up dating their knowledge and skills through training. Cumberland Care Home DS0000061986.V363269.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 & 38 People who use this service experience adequate quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. The manager has the appropriate qualifications and experience to manage this service. The manager and senior staff need to ensure that staff are working in line with policies and procedures to ensure the health and welfare of people who use the service. Records need to be well maintained and up to date. Staff make regular checks to ensure the health and safety of people who use the service. EVIDENCE: Cumberland Care Home DS0000061986.V363269.R01.S.doc Version 5.2 Page 24 The manager has the appropriate skills and qualifications to manage the service. However the manager and senior staff need to focus on monitoring what is happening in the home to ensure that staff are following policies, procedures and current good practice. In particular, to ensure the health and welfare of people who use the service, the practices and recording in relation to wound care and medication must be monitored. As noted previously where action plans have been produced the manager and senior staff need to ensure that these are carried out. At the time of the first visit to the home the records relating to staff supervision were not up to date. The records held by the manager at that time indicated that a number of staff had not received supervision since January of this year. At the second visit to the home these records had been up dated. Facilities are available for people who use the service to deposit small amounts of money with the home for safekeeping. We looked at a sample of these records and found them to be well maintained, up to date and accurate. The organisation has in place quality monitoring and assurance systems. An annual review of the service is carried out which includes seeking the views of people who use the service and or their representatives. Feedback from surveys is sent to the head office and the results are fed back to the home manager. An action plan is produced taking into consideration the views of people who completed surveys. Staff carry out regular checks on the environment and equipment to ensure the health and safety of people who use the service, staff and visitors. We found these records to be well maintained and up to date. Cumberland Care Home DS0000061986.V363269.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 3 X 3 X X X 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 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 2 3 Cumberland Care Home DS0000061986.V363269.R01.S.doc Version 5.2 Page 26 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 15(1)(2) Requirement In order to ensure that each person receives the support and care they need all care plans must be completed, compiled in consultation with the person and or their representative and reviewed on a regular basis. Timescale of 31/08/07 not met. To make sure that each person receives the support they need staff must be provided with clear, detailed instructions on the care to be given and any interventions. Information must be available to staff if any care is to be provided by qualified staff only. Timescale of 31/08/07 not met In instances where the freedom of movement of individuals is restricted a risk assessment must be carried out in consultation with other professionals and the residents representative. Timescale of 31/08/07 not met DS0000061986.V363269.R01.S.doc Timescale for action 01/08/08 2. OP7 12(1)17 (1)(a) Schedule 3 (k) 10/07/08 3. OP7 12(2)(3)1 4(2) 01/08/08 Cumberland Care Home Version 5.2 Page 27 4. OP8 12(1) 5. OP8 17(1)(a) Schedule 3 (k) 6. OP8 13(1)(b) 7. OP9 13(2) 8. OP18 13(6) 9. OP31 17(3)(a) To make sure that the health and welfare of residents is protected a review of the manner in which pain is assessed and addressed must be carried out. Timescale of 31/08/07 not met. To ensure the health and welfare of people who use the service an up to date record of wound care must be maintained. This record must include the treatment given, the condition of any wound and the date. To ensure the health and welfare of people who use the service staff must provide clear records of actions taken where risk assessments indicate a high level of risk in relation to the health of any individual. To ensure the health and welfare of people who use the service a clear, up to date and signed record of medication administered or refused must be maintained. All medication must be signed of at the time of administration. The record of medication must be regularly monitored by senior staff. In order to protect people who use the service from abuse staff must be provided with clear information on how they are expected to relate to people who use the service. In order to protect the health and welfare of people who use the service the management must ensure that records are well maintained, up to date and accurate. 04/07/08 04/07/08 04/07/08 04/07/08 04/07/08 04/07/08 Cumberland Care Home DS0000061986.V363269.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 OP1 Good Practice Recommendations It is recommended that the views of people who use the service, from quality monitoring surveys, are included in the welcome pack. This will allow prospective residents to see what people living at the home feel about the support they receive. The addition of photographs of the home, staff and activities may provide people who are living with dementia with more information on the service. Consideration should be given to using moulds for people who need a pureed diet. This would provide a better presented meal. Consideration should also be given to providing more food around the home for those people who use the service who find it difficult to go through a whole mealtime sitting at a table. In order to make mealtimes a more social event consideration should be given to protected mealtimes. In order to protect people who use the service a review of how staff are supported by their colleagues, senior staff and the organisation, to deal with their own feelings when supporting people should be considered. Consideration should also be given to providing information to visitors on what they should expect from staff and what to do if individual staff do not live up to these expectations. 6 OP19 In order to provide more variety for people who use the service consideration should be given to providing covered outdoor areas or sheds in the garden. 2. OP15 3 OP15 4 5. OP15 OP18 Cumberland Care Home DS0000061986.V363269.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Cumberland Care Home DS0000061986.V363269.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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