Inspection on 14/08/07 for Cumberland House

This inspection was carried out on 14th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cumberland House 17/06/08

Cumberland House 30/04/06

Cumberland House 06/12/05

Cumberland House 21/08/05

Cumberland House 11/02/05

Cumberland House 01/09/04

Similar services:

1 Marten Road

Daubeney House

Three Gables

Aldwick House

49 Glendale

The Springs Community

Crossways Community

Belle Vue Country House

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

CARE HOMES FOR OLDER PEOPLE Cumberland House 21 Laton Road Hastings East Sussex TN34 2ES Lead Inspector Jason Denny Key Unannounced Inspection 14th August 2007 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 House DS0000021084.V349010.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 House DS0000021084.V349010.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cumberland House Address 21 Laton Road Hastings East Sussex TN34 2ES 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) 01424 422458 Linda@chouse21.fsnet.co.uk Mrs Linda Gratton Mrs Linda Gratton Care Home 18 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (18) of places Cumberland House DS0000021084.V349010.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of service users to be accommodated is eighteen (18) Service users must be older people aged sixty five (65) years or over on admission Service users with mental health needs, excluding dementia, only to be accommodated To allow one specific resident who is under 65 years of age to be accommodated 30th April 2006 Date of last inspection Brief Description of the Service: Cumberland House is registered to provide accommodation for up to 18 older people suffering from a mental health issues and admits people with low to medium dependency needs. The home currently has an exception statement in place, which allows for one resident to be placed under the age of 65 years of age. The premise is a large detached property situated in Hastings. It has mainly single rooms (three doubles) situated on the first and second floors (most of which are en suite, all have a wash hand basin). Residents have the use of a lounge, conservatory (smoking area), dining room and kitchenette on the ground floor. There is no lift and the home is not suited to those with mobility problems. The home has a large well-maintained rear garden with seating and lawn area for residents to enjoy and the front garden also has seating for residents. Ample car parking is available within the street outside and the home’s driveway. The building is located a 15 minute walk from the town centre, is close to a bus stop and a shorter walk to the nearest shops. The home currently has 16 residents. The service’s range of fees are from £330.14 to £374.87 per week. The lower rate is based on what East Sussex pays. The higher rate is based on what London boroughs pay. Those who are self funding [private] pay he same as what the lowest rate is and receive the same facilities as those funded by Social Services. The latest Inspection report is sent out to any enquirer who expresses an interest in the home. A copy of the report is obtainable via the manager. Cumberland House DS0000021084.V349010.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Unannounced key Inspection, which included a visit to the home which took place between 10.00am and 4.00pm on August 14, 2007. This inspection process covers the period since the last inspection April 30, 2006. The focus of the inspection was on the newest, along with the care of some well-established, residents. The visit also focused on improvements in those outstanding matters since the last inspection such as medication and training. Some diversity and equality areas were explored in relation to lifestyles. Care records for four Residents along with health and medication needs were looked at. Discussions with management looked at progress since the last inspection. The inspector toured all communal areas of the home with meal arrangements examined. A record of complaints was inspected. Staffing was looked at in detail along with how the home is managed. During and following this inspection three relatives were spoken with along with three social workers and nurses who visit and place people in the home. Seven [7] of the current 14 Residents were spoken with in detail during the inspection all of who confirmed a good service. The visit also included discussion with some staff and observation of care-practices. The home was sent by the Commission an annual quality assurance assessment [AQAA] due for completion and return by the end of May 2007. This AQAA had not been received by the day of the inspection, which meant it could not be used to plan the inspection or inform the draft report. Survey cards were sent to the home 2 weeks before the inspection. Due to the tight timescales with survey cards the inspector phoned a number of relatives and professionals involved with the home. One [1] area is judged as Excellent, two [2] as Good, and four [4] areas are Adequate and in need of some improvement. What the service does well: Comments received from residents who could offer an opinion all described the home in positive terms with typical statements such as “Food is good…you have freedom can do what you want… staff are good…it is pleasant here. No problems “. Comments received from relatives of residents all used the word “good” and felt that particular Residents had settled in well and that staff and the manager are approachable, helpful and friendly. Social workers and health professionals who work with the home described the service as good. All remarked on how the home is quick to seek and implement advice and maintain good communication. All took the view that “this home is one of the good ones”. It is evident how well the home works with some complex personalities. Staff are attentive. Cumberland House DS0000021084.V349010.R01.S.doc Version 5.2 Page 6 Residents benefit from a homely environment and relative small number of Residents [currently 14] which allows everyone ample communal space including three separate meeting/reception rooms. This supports a relatively calm and relaxed atmosphere. The range of opportunities and activities for Residents is exceptional with considerable consideration given to individual needs and preferences. Some activities include gardening projects and pottery classes along with frequent opportunities to visit the local community. The home is good at ensuring that Residents are not unnecessarily restricted and as far as possible have freedoms such as the front door which is currently not locked with an alarm system which can be used if there is a serious risk to any Resident leaving the home unattended. The home is kept to be clean. The home’s management respond quickly to changing needs in order to protect all Resident’s interests. What has improved since the last inspection? What they could do better: Despite recent improvements to recording actions taken in respect of complaints from Residents this did not ensure that a serious complaint of June 2006 was reported to the necessary authorities with no written record of what action was taken to protect a vulnerable Resident. The manager was required on the day of the Inspection to immediately report this incident. The reporting procedure for allegation of abuse needs to clearer and followed in practice. Staffing levels need to be reviewed to ensure that at all times such as weekends there is sufficient staff for care needs and other areas such as cooking and cleaning. Better planning is needed to deal with staff sickness and annual leave to ensure a well run home. Cumberland House DS0000021084.V349010.R01.S.doc Version 5.2 Page 7 To protect Residents all staff need to complete application form prior to employment. A range of records needs improving to be clearer, to protect Residents, prevent confusion, and to be in line with data protection guidance. This relates to having a clear rota of all persons working in the home, a record of visitors, and Residents having their own daily notes. Residents receive good care based on observations and comments from people in the home and those who visit. However, the way in which this take place needs to be better recorded and should include more information on Residents individual choices, preferred routines, rights, and capacity. Care- plans vary from being good, detailed and are regularly reviewed whilst others are not. The home has a number of informal ways of ensuring that Residents remain satisfied and that the wishes of relatives and other professionals are included in the running of the home. However, there should be more regular surveys of views with an action-plan published as the last survey was before the last Inspection 18 months ago. In the short term the home is required to complete and return the Annual Quality Assurance Assessment within a month of the Inspection to identify what the current and future plans of the service are. Relatives of those who are self funding [private] are happy with contract arrangements and fees although the home is asked to ensure that all Residents and their representatives have Cumberland house’s terms and conditions [the contract] to protect their rights. 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 House DS0000021084.V349010.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 House DS0000021084.V349010.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): 2, 3, 4, & 5. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The home provides both prospective and existing Residents, with a good level of information, with the exception of contracts for some. The way in which the home assesses prospective or existing Residents ensures that it currently meets needs, although to protect Residents interests, better recording is necessary. EVIDENCE: The management of the home confirmed on an inspection of records that an amendment is necessary for contracts [terms and conditions] to show how fees vary when a Residents is self-funded. The manager and the deputy confirmed that the range of fees is now £330.14 to £374.87. The lower fee being what East Sussex pays for and the higher rate what London boroughs pay. It is positively noted that self-funding Residents pay the lower rate. The manager Cumberland House DS0000021084.V349010.R01.S.doc Version 5.2 Page 10 and deputy confirmed as seen in records that Residents who are Social Services funded have a financial contract with Social Services but no record of a signed contract of Cumberland house’s terms and conditions. The home was found to have general terms and conditions within its own documentation such as the Service User [resident’s] guide and is given to people to look at when they make inquires. The manager confirmed that organising this and ensuring that the contract for all Residents has all the necessary information indicated in the new regulations would be done shortly. The home was also advised to get terms and conditions signed on or before admittance to protect everyone rights. No relatives or Residents indicated concerns with contracts. One relative of a self- funding [Private] Resident spoken with felt the home provided good value for money and that the resident is only sharing a room as no single were available at the time of deciding to move in. Assessments are carried out by external agencies, which consist of Full community care assessments for new residents as seen in records. Intermediate care is not provided. The inspector found on examining four examples of Residents care-planning information that the home had not carried out its own pre- assessment prior or after the person moved in to the home. The manager and deputy confirmed that they visit prospective new residents or they visit the home prior to admittance where they carry out their own assessment although this is not recorded. The home was also advised to use a comprehensive pro- forma for carrying out their assessments. A Suitable blank sample from was found in a care-plan. One of the newer Residents had some sections of their care plan left blank which might have been avoided if the home had carried out their own preassessment in those areas. The home was also advised that they need to write to prospective new Residents and their representatives prior to moving in to confirm that they can meet their assessed needs. Social care assessments do not always arrive prior to someone moving in or may have information, which needs updating hence the need for the home to carry out their own written assessment. Newer Residents were found to have settled in well to the home. One of the Residents and their relatives confirmed that they had a trial visit before moving in. Despite some gaps in some care-plans linked to assessments it was evident that the home was meeting needs as confirmed by Residents, relatives, and social services. Cumberland House DS0000021084.V349010.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. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Residents clearly benefit from good, skilled and prompt care although better recording of how this is done and of each individual’s full range of needs will more clearly evidence that Residents are receiving care as they require it. Medication arrangements have improved reducing the risk to Residents. Residents can feel confident that they will be treated with dignity and respect. EVIDENCE: The inspector sampled four [4] care –plans, two [2] of which related to newer Residents. Risk assessments were found to be in place for behaviour and falls. These risk assessments were found to be reviewed on a regular basis for some Residents. One care plan of Residents who had moved in during 2005 was found to have not had any review of the original care-plan. Some sections of the care-plan such as strengths and weaknesses were not filled in except the Cumberland House DS0000021084.V349010.R01.S.doc Version 5.2 Page 12 section on sleep, along with the section on goals. On a general note some care planning information lacked precision around dates of entry so it was not always possible to assess whether assessment information was received after the person was admitted into the home. Residents do not have daily notes in their own individual records and care plans files so it is not possible to show how day-to-day care plans are being actioned. Significant events are said to be recorded in the plans although gaps between entries was found to be a concern in one instance when a significant event had taken place in June 2006 with no entry for that Resident on the day of the incident. Another care-plan was found to be exceptionally well detailed and rewritten in January 2007. This plan covered the full range of needs. The deputy manager explained how she and another staff person had been motivated to develop this care plan fully and keep under review as part of their college course. The deputy explained how she hopes to negotiate with the manager a system of involving the staff more in the review of care-plans and set up a system of focusing on 1 to 2 care plans a month to bring them all up to standard. A care plan of another Resident whose behaviour has become more challenging was found to have had regular updates and reassessments such as a new care assessment in May 2007. The home was found to be liaising closely with social services to ensure that the placement continues in everyone’s best interests. The Resident confirmed to the inspector some positive aspects of living in the home and their social worker confirmed that the home works hard to meet the resident’s needs. The home’s medication policy and dispensing and administration procedure is comprehensive and based on best guidance. Senior Staff were observed to dispense medication at lunchtime and did so in an appropriate manner. One resident declined their medication during lunch with the staff member needing to return this to the cabinet until the Resident was ready. It was not evident whether the staff person had ascertained the Resident’s wishes in advance. The issue at the last Inspection has been resolved in relation to medication administration sheets being signed after medication is given with the inspector finding no gaps on the records examined. Residents were observed to be alert and the assistant manger explained how medication is kept to a minimum to avoid the risk of over sedation. Health care needs are well met and currently GP’s, the District Nurse, Community Psychiatric Nurses and the continence advisor support the home. A chiropodist visits the home regularly as seen during the inspection. Residents weight is recorded in the care plan to enable the monitoring of any weight loss or gain. Relatives and professionals indicated the prompt way in which health needs are met. Cumberland House DS0000021084.V349010.R01.S.doc Version 5.2 Page 13 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. Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. The home provides an excellent range of activities based on resident preferences including individual opportunities, which are advertised and regularly reviewed with Residents. Residents benefit from experiencing routines that are flexible and can be confident they will be treated as individuals. Residents enjoy food, which is good, under constant review, varied, healthy, and in good portions. EVIDENCE: The home offers a variety of activities on a weekly basis including pottery, aromatherapy, tai chi and music therapy. Residents confirmed that these activities are very much enjoyed. One newer resident is very active in the garden and the results are a large well-maintained area, which is enjoyed by the majority of residents in the right weather. Residents confirmed that they also watch television, read, and listen to music, the radio and play cards, some Cumberland House DS0000021084.V349010.R01.S.doc Version 5.2 Page 14 in the communal areas and others preferring their own rooms. During the Inspection some Residents were observed to use the main lounge and read daily newspapers or in the conservatory where they can smoke and socialise. One Resident returned from a local church coffee morning. It was evident such as at lunchtime the degree of compatibility of Residents who have some common interests. Several residents access the wider community on a regular basis using the local shops, public houses and meeting friends and family. Residents confirmed how the close proximity to a local bus stop is helpful. Since the last inspection the home has employed an activities specialist 12 hours per week. Who as seen during the inspection and confirmed by Residents takes out people on 1:1 trips in to the community in their car. Inhouse activities such as bingo took place during the afternoon of the visit. The only question in relation to activities relates to the weekend where staffing significantly reduces to just 2 on each shift when they are also expected to cook and clean. Overall activity provision is exceptional and many Residents are able to organise their own affairs without support. Residents also benefit from a navigation board on display in the home, which confirms the day of the week and other relevant information. Residents are encouraged to handle their own finances and/or their personal allowances. Advocacy information is displayed and available. Contact with families and friends are encouraged. Relatives and professionals indicated how they encouraged to visit unannounced and always find staff to be knowledgeable, friendly, and open. Menus rotate regularly and are varied. Although there is no advertised choice residents confirmed that alternatives are available. The list of the forthcoming weeks meals were found to be helpfully displayed on a menu board. Residents confirmed how they enjoyed the meals prepared by the Russian cook along with the variety of dishes. The inspector sampled a desert and found it to be wholly satisfactory. The cook is aware of likes and dislikes and an alternative that the resident would like is cooked. All Residents who could give an opinion indicated that they liked the food served and the portions. Fresh fruit was found to be available for Residents along with regular snacks between meals. One relative raised a query with the inspector about whether a particular Resident is given enough support to eat their meals with this possibly due to staffing levels at certain times such as weekends. Cumberland House DS0000021084.V349010.R01.S.doc Version 5.2 Page 15 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. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from living in a home that encourages them to raise their views and records basic details of their concerns brought by either them or their advocates. Resident’s will be better protected once the manager and staff improve their practice in terms of ensuring that all necessary authorities are made aware in a timely manner when there are allegations of abuse in the home. EVIDENCE: Complaints or concerns about the service are recorded as seen in over 10 entries into the complaints book since the last inspection and over the last year. The complaints were found to be either raised by Residents themselves or by advocates such as staff and relatives. The concerns generally covered areas such as food, the cleanliness of beds, and behaviour of other Residents and staff. The deputy manager confirmed that all issues had been resolved promptly and no longer takes place. It was also noticeable that the rates of complaints have reduced with just two this year with these quickly resolved as they related to laundry in the wrong room and a Resident declining to wear winter clothing. The complaints book also showed recent signs of improvement in that it was noticeable that for more recent entries a section on action taken Cumberland House DS0000021084.V349010.R01.S.doc Version 5.2 Page 16 had been completed. The deputy manager following management training has introduced this method. Of serious concern was a complaint of June 12, 2006 [had incorrectly been listed as June 13]. It was positive that a record was made in the homes complaint book and that the deputy manager openly elaborated on the basic details in the file. However it is concerning that this complaint which involves an allegation of staff assaulting a Residents hand, which was confirmed by another staff person and the resident affected, was not reported to the Commission and social services at that time in order to allow an investigation. The complaints book does not show what actions the home took although the manager confirmed verbally that she did speak to the staff person who the complaint relates to, and asked her to cut her nails. An immediate requirement was made in respect of the manager fully reporting the incident of June 12 2006 to the Commission and Social Services including what actions have been taken to protect Residents. Social Services will then advise of any action plan and recommendations. The management of the home were unclear what social service department to contact with it not listed in their protection from abuse [safeguarding adults] reporting procedure. The home was therefore advised to update the procedure and make sure all staff employed in the home is aware. All staff complete protection of Vulnerable Adult [safeguarding adults] training. Staff were observed to treat Residents with respect and Relatives and social workers described the care as good. Staff spoken with indicated clear knowledge of what might constitute alleged abuse and how to report abuse to the manager. The home was advised to ensure that staff are aware of their duty to report outside of the home if they are not clear that management are taking necessary action. Cumberland House DS0000021084.V349010.R01.S.doc Version 5.2 Page 17 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, 24, & 26. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from living in a fresh, clean, warm, and homely environment, which is spacious and well maintained. The homes rear garden is popular with Residents who are encouraged to support its maintenance. EVIDENCE: The inspector toured all communal areas and some bedrooms. The home was again found to be clean, warm, spacious, comfortable and homely. The home is in keeping with local properties, and the grounds are safe and well maintained. The homes management confirmed that fire checks and training continues to be regularly organised. The home has taken advice from the local Cumberland House DS0000021084.V349010.R01.S.doc Version 5.2 Page 18 fire department and taken all necessary action in respect of previous recommendations as confirmed by the manager. The kitchen was found to be clean and well maintained as was the impressive rear garden which is popular with Residents some of who help with its maintenance and growing of vegetables. Five bedrooms that were looked at were found to clean, fresh smelling, and personalised. None of the rooms are numbered although some have Residents names. It is noted that a number of Residents share bedrooms which is a based on agreement. One of the newer Residents who is self funding did not have a choice of single room when moving into the home, due to none being available, but he and his family were happy with the person who he shares with. The other resident referred to indicated that he enjoyed sharing with the newer Resident. The room was found to be a large, complete with an en-suite shower, and suited to both person’s needs. Cumberland House DS0000021084.V349010.R01.S.doc Version 5.2 Page 19 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. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from experienced staff that receive continual training with all getting a proper induction in to the job. The home needs to improve staffing arrangements so that Residents can be confident that all shifts including weekends have sufficient numbers and to prevent staff becoming tired and affecting standards of care. Recruitment procedures based on protecting Residents have generally been followed and no one has been put at an obvious risk. However all staff need to complete application forms prior to commencing employment. EVIDENCE: On the day of the inspection there were 14 Residents [registered for 18]. The rota on display in the office showed 3 care workers on the morning shift although it was confirmed that one had gone sick. The deputy manager confirmed that there was no one available to ensure 3 carers on shift that morning with the manager covering annual leave on the afternoon shift. The manager was not found to be on the rota other than when she works a careshift. The deputy manager who works 9-3pm Monday to Thursday was not found to be on the rota although she does assist with Residents needs such as Cumberland House DS0000021084.V349010.R01.S.doc Version 5.2 Page 20 administrative paperwork, meetings, and going on shift in a crisis. The afternoon shift comprised of the manager an experienced carer and new staff person on her first shift under supervision. During the afternoon the activities coordinator arrived who works 12 hours per week with these hours not on the rota. The rota does not show the capacity of each worker. Apart from an unclear rota there is a concern about weekends where there are no cooks or cleaners on shift and where there are just 2 staff who are expected to do meet care needs, cook, and clean. One of these staff members who works nights also works days and an inspection of the weekend rota regularly showed this person working a waking night through to the morning shift then going home for 6 hours and then returning to work another waking night followed by a early shift. The deputy manager indicated that tiredness of this staff person has been cited as a concern. The manager on the advice of the inspector agreed to conduct a review of current staffing arrangements and ratios. Some visitors to the home queried whether staffing levels were sufficient at all times such as weekends. All current Residents with the exception of one observed, mobilise without support and are generally low dependency. The deputy manager confirmed during the Inspection visit that 50 of all care staff now have a National Vocational Qualification at Care level 2 or above. All other staff has completed foundational training or is on National Vocational Qualification in Care level 2 course. Staff spoken with identified training as good and ongoing such as medication training and National Vocational Qualification in Care over the last year. An inspection of three existing staff files showed all had suitable Police CRB Checks and that all necessary checks had been carried out prior to commencing employment. An Inspection of a new staff person starting on the day of the inspection showed that all initial checks [with one exception] had been completed including a check [POVA first] on the protection of vulnerable adults register. Although this new person had submitted a CV she has not been requested to complete an application form prior to commencing employment. The home has introduced an induction workbook, which is based on 12 week Skills for Care recommended Induction programme. This was found to have been organised for a new member of staff who was starting her first shift in the home under the supervision of the manager who was observed showing her the key aspect of the home. An inspection of other staffing files found completed induction books in place. Cumberland House DS0000021084.V349010.R01.S.doc Version 5.2 Page 21 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, 37, & 38 Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from living in a home, which has an attentive, experienced popular, and qualified, management team. Further evidence of how quality is being measured and how this involves Residents is needed. Incidents, which affect Resident’s welfare, need to be reported in a timelier and open manner along with showing comprehensive protection plans. Improvements are needed to ensure that Residents are safe at all times. EVIDENCE: The service benefits from the commitment of both the Deputy Manager and the Registered manager who is also the owner of the home. Residents, relatives, Cumberland House DS0000021084.V349010.R01.S.doc Version 5.2 Page 22 ands social workers spoken with praised the attention and skills of the management team who maintain positive communication. The service has introduced a formal quality assurance system to ensure the resident’s views underpin the homes development. However the last survey was before the last Inspection with the results of the QA surveys analysed and published in March 2006, a copy of which is on the file. Prior to this inspection in April 2007 the Commission sent the home an Annual Quality Assurance Assessment for completion and return by the end of May 2007. By the day of the Inspection August 14, 2007 this Annual Quality Assurance Assessment had not been completed or returned. The manager was advised to prioritise this before attending to a new survey of Residents views and an annual development plan. The Annual Quality Assurance Assessment is intended to show the reader what the home has achieved, what the barriers to progress have been and what it future plans are for the coming year. Without this completed document the inspector is unable to comment on the homes assessment of how it currently, and will, achieve quality. Two examples of Residents monies managed on their behalf by the home were examined and were found to be in order with accurate running totals and receipts. Most Residents manage their own monies and have their personal allowance paid to them directly by the home on receipt as confirmed by Residents spoken with. Supervision is carried out once every two months for care staff, as confirmed by staff and the management of the home during the inspection. The service has in place a ‘Code of Rights for residents’, and an ‘Equal Opportunities Statement’, with diversity seen as a positive asset. There is also in place an Equal Opportunities and Fair Treatment Policy for Service Users and Staff, along with a ‘Personal Relationships and Sexuality Policy, and a policy for dignity autonomy and rights. The management of the home in the absence of a completed Annual Quality Assurance Assessment to inspect in respect of health and safety checks and maintenance, verbally confirmed that all areas were in good order. They also confirmed that all recommendations in respect of fire safety have been carried out and regular checks continue to be made. Cleaning fluids and materials were found in one open bedroom unattended on the second floor of the home where 3 Residents are based with no staff present in b reach of heath and safety regulations. The transporting of a Resident in wheelchair was observed to be done without using the footplates. The manager and her deputy confirmed awareness that this is an area for improvement in terms of staff appreciation of health and safety and the need to take their time over such tasks. Cumberland House DS0000021084.V349010.R01.S.doc Version 5.2 Page 23 On arrival at the home the inspector was unable to confirm the duration and purpose of the visit by reference to a visitors book. The home has a shift handover sheet, which records each Resident progress with one-line entries and includes a section about whether they had visitors. This information does not show duration or purpose of a visit and needs to be stored separately. The home is advised to maintain any records on individual Residents in an individual file for data protection reasons so that access to one individual’s daily notes does not compromise the privacy of another person. The manager was advised to immediately report on the day of the inspection the incident of suspected abuse dating from June 12, 2006 including the full circumstances. The inspector and social service made contact with the home 3 days after the Inspection as such a report had not been sent with the manager confirming it would be done by that or the next working day. That same day a fax was received by Social Services regarding the incident. Cumberland House DS0000021084.V349010.R01.S.doc Version 5.2 Page 24 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 2 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X 2 2 Cumberland House DS0000021084.V349010.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO 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 OP2 Regulation 5 as amended 2006 Requirement That the Registered person must ensure that all residents or their representatives’ sign and have a copy of Cumberland House’s terms and conditions [the Contract]. That the contract contains all items indicated in the new amended regulation effective from September 2006. That the Registered person must ensure that the home carries out its own written assessment before admitting anyone. That the home confirms in writing that it can meet assessed needs prior to admittance. That the Registered person must ensure that all care plans are comprehensive with all the aims identified, assessed and regularly reviewed. That the Registered person must ensure that complaints made on behalf of residents are thoroughly investigated and followed up with a record kept to demonstrate what action has been taken with all necessary DS0000021084.V349010.R01.S.doc Timescale for action 14/12/07 2. OP3 14[1]&[2] 14/12/07 3. OP7 15(1) 14/12/07 4 OP16 22 14/09/07 Cumberland House Version 5.2 Page 26 5 OP18 13[6] 6 OP27 17[2] schedule 4 18[1][a] 7 OP27 8 OP29 19 9 OP33 21 10 OP38 17[2] schedule 4.17 37[1][g] 11 OP38 authorities contacted in a timely manner as appropriate. That the Registered person must ensure that the home s procedure for reporting suspected abuse is comprehensive, clear, and is followed in practice. That the Registered person must ensure that the home maintains a clear rota, which identifies everyone who works in the home along with their role That the Registered person must ensure that a review is carried out of current staffing levels especially at weekends to ensure that all times staff are deployed in sufficient needs to meet assessed needs. That the Registered person must ensure that thorough recruitment practices are carried out. That applicants complete an application form prior to commencing employment in the home. That the Registered person must ensure that a Annual Quality Assurance Assessment required by the Commission is completed and returned by the timescale indicated. [Original timescale May 31, 2007] That the Registered person must ensure that an accurate and appropriate record is kept of all visitors to the home. That the Registered person must ensure that all Regulation 37 notifiable incidents are reported without delay. That an incident of June 2006 is immediately reported. An immediate requirement made on the day of the inspection. DS0000021084.V349010.R01.S.doc 14/09/07 14/09/07 14/11/07 14/08/07 14/09/07 14/10/07 14/08/07 Cumberland House Version 5.2 Page 27 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 Refer to Standard OP37 OP38 Good Practice Recommendations That each Resident [service user] has individual daily notes maintained in line with data protection guidance. That a review of health and safety practices in the home is carried out to ensure that risks are minimised. Cumberland House DS0000021084.V349010.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 House DS0000021084.V349010.R01.S.doc Version 5.2 Page 29 - 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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