CARE HOMES FOR OLDER PEOPLE
Cumberland House 21 Laton Road Hastings East Sussex TN34 2ES Lead Inspector
Alexis Reilly Unannounced 21 August 2005 9:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cumberland House H59-H10 S21084 Cumberland House V239760 210805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Cumberland House Address 21 Laton Road Hastings East Sussex TN34 2ES 01424 422458 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Linda Gratton Mrs Linda Gratton Care Home 18 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (MD) 18 of places Cumberland House H59-H10 S21084 Cumberland House V239760 210805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The maximum number of service users to be accommodated is eighteen (18) 2. Service users must be older people aged sixty five (65) years or over on admission 3. Service users with mental health needs, excluding dementia, only to be accommodated 4. To allow one specific resident who is under 65 years of age to be accommodated Date of last inspection 11 February 2005 Brief Description of the Service: Cumberland House is registered to offer placements to 18 people with a diagnosis of past or present mental disorder, excluding learning disability, dementia or alcohol & drug related disorders. The service currently has an exception statement in place, which allows for one service users to be placed under the age of 65 years of age. The building is situated close to local shops and the town centre is within easy reach. The accommodation includes communal space on the ground floor which consists of a conservatory which is used for people who wish to smoke, a dining room and a living room. Bedrooms are located on the first and second floors. There are ten single rooms, seven of these have en suite facilities, there are four double bedrooms and each of these has en suite faciliities. There is a large garden at the rear of the building. The service currently has 16 residents placed one of these being on a respite placement. Cumberland House H59-H10 S21084 Cumberland House V239760 210805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection began at 9.30am and lasted for 3 hours. The inspector examined the care plans and assessment documents of three residents two of these were of residents who had recently moved into the service. Further documents examined were the accident book, sheets which record the administration of medication, risk assessments and menus. The inspector spoke with the senior staff member on duty and spoke with three residents. What the service does well: What has improved since the last inspection? What they could do better:
Quality assurance systems should be set in place to receive the views of residents and their families and other stakeholders. The results of any quality assurance surveys should be published. This requirement is outstanding from the last inspection. Regular fire drills must be held at least twice a year and be recorded. This requirement is also outstanding from the last inspection. A fire safety adviser should assess the premises on a regular basis to ensure all current fire safety standards are met. Fire safety training should be by a fire safety expert.
Cumberland House H59-H10 S21084 Cumberland House V239760 210805 Stage 4.doc Version 1.40 Page 6 The risk assessments with regard to one particular resident must reflect the level of risk associated with consuming alcohol and becoming disorientated and injured away from the home. Medication Administration Records must be filled in after staff members have administered medication. 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 House H59-H10 S21084 Cumberland House V239760 210805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Cumberland House H59-H10 S21084 Cumberland House V239760 210805 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 & 6 The service ensures it has gained the relevant background information for a resident prior to offering them a place in the service. EVIDENCE: The care plans and admission documents for recently admitted resident to the home, were examined. The relevant admission documents were available, these included discharge notes from the local hospital and copies of District Nursing notes, Occupational Therapy Reports, a discharge summary and community nursing notes, and a copy of the last Care Programme Approach report. The service does not offer intermediate care facilities. Cumberland House H59-H10 S21084 Cumberland House V239760 210805 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 & 9 Care plans are detailed however risks associated with individuals behaviours need to be constantly updated and risks revaluated if applicable. EVIDENCE: Care plans examined on the day of the inspection had the relevant details recorded in them. This included a description of the resident and a personal history. Information was available with regard to personal care, and procedures for meal times. Care Plans identified ongoing needs and risk assessments, strengths and weaknesses. Albeit the home maintains risk assessments, where specific risks are identified in respect of individual residents, e.g. risk of falling whilst under the influence of alcohol, the service needs to ensure that these assessments reflect the level of risk present, and that clear risk management strategies are in place, particularly where a resident is unaccompanied in the wider community, and deemed to be at risk. Medication Administration Records were examined on the day of the inspection and found to have significant gaps in them, 35 in total. Weight charts had been completed for residents and history of falls where recorded appropriately.
Cumberland House H59-H10 S21084 Cumberland House V239760 210805 Stage 4.doc Version 1.40 Page 10 There was also a record in the care plans, of the use of a pressure sore chart, dental and oral hygiene assessment, and continence assessment checklist. A clothing inventory was also recorded. Cumberland House H59-H10 S21084 Cumberland House V239760 210805 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 & 15 The service offers a variety of activities on a weekly basis. The majority of the residents access the community independently to pursue their own interests. EVIDENCE: The service offers a variety of activities in the home on a weekly basis these include tai-chi, pottery and aromatherapy classes. There is also a musician who visits the service every two weeks. Musical and theatre visits are also offered to residents. Some residents retain family links. Family and friends are invited into the home at any reasonable time. Staff members will assists residents in accessing the community if this is appropriate. Staff will take residents out on a one to one basis, in their car. This has been used to take residents to visit relatives. Residents can leave and enter the home when they wish and can bring personal possessions into the home. Menus were varied and balanced. The service operates a flexible approach to meal times. Residents come down for tea when they are ready to eat. Residents choose when to rise in the morning and when to retire at night. Cumberland House H59-H10 S21084 Cumberland House V239760 210805 Stage 4.doc Version 1.40 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The service has an accessible complaints procedure in place. Complaints from residents are dealt with appropriately. EVIDENCE: The service has an accessible complaints procedure in place. Staff within the service ensures that all complaints made by residents are recorded appropriately. The service deals with complaints appropriately. Cumberland House H59-H10 S21084 Cumberland House V239760 210805 Stage 4.doc Version 1.40 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 21 & 22 The service is in the process of ensuring any specialist equipment required for the safety of the residents is fitted. EVIDENCE: The home has adequate assisted baths to meet the needs of the residents placed. There are three communal bathrooms on the ground floor. One of these is non-assisted, one shower room and one seated bath. On the first floor is one non-assisted bath, 1 bathroom where a hoist is being installed and one seated bath. Following a visits and an assessment of the premises by a suitably qualified professional the following alterations are in the process of being implemented, call systems are being fitted in en suites and a handrail is being fitted to the wall for garden access. Cumberland House H59-H10 S21084 Cumberland House V239760 210805 Stage 4.doc Version 1.40 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 30 Staff have not achieved the required NVQ level 2 training. EVIDENCE: The home has not met the requirement that 50 of staff are trained to NVQ Level 2. This has been highlighted in the last two inspection reports. The Inspector has been assured by the home’s manager that 50 of staff are due to commence training on NVQ level 2 this year. Cumberland House H59-H10 S21084 Cumberland House V239760 210805 Stage 4.doc Version 1.40 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,36 & 38 Staff require further training in areas of fire safety and staff supervision to ensure the best interests and welfare of the residents are protected. EVIDENCE: The Registered Manager has now completed NVQ level 4. The service must ensure it has a quality assurance system in place that gains the views of the residents, families and other professionals. Staff involved in the formal supervision of staff must undertake relevant training, however this training has been arranged for September 2005. Regular fire drills must be held at least twice a year and be recorded. Fire safety training should be by a fire safety expert. A fire safety adviser should assess the premises on a regular basis to ensure it meets the required standards. Staff meetings are held once every three months. The minutes of these meetings are pinned on the staff notice board following the meeting. Residents meetings are held once every three months, and a formal record of these meetings are kept also.
Cumberland House H59-H10 S21084 Cumberland House V239760 210805 Stage 4.doc Version 1.40 Page 16 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION x x 3 3 x x x x STAFFING Standard No Score 27 x 28 2 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 x 2 x x 2 x 2 Cumberland House H59-H10 S21084 Cumberland House V239760 210805 Stage 4.doc Version 1.40 Page 17 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 OP28 Regulation 19(5)(b) Requirement That a minimum of 50 if care staff are trained to NVQ level 2 or equivalent by 2005. (Outstanding from the last two inspections) Quality assurance systems should be set in place to receive the views of service users and their families and other stakeholders. (Outstanding from the last inspection) The results of any quality assurance surverys should be published. (Outstanding from the last inspection) Staff involved in the formal supervision of staff must undertake relevant training. (Outstanding from the last inspection) Regular fire drills must be held at least twice a year and be recorded. (Outstanding from the last inspection) The risk assessments with regard to one particular resident must reflect the level of risk associated with consuming alcohol and becoming disorientated and injuried away from the home. Timescale for action 1st December 2005 1st December 2005 2. OP33 24(a)(b) (2) 3. OP33 24(a)(b) (2) 18(1)(i) 31st December 2005 31st December 2005 1st December 2005 1st October 2005 4. OP36 5. OP38 23(4)(3)& 23(4)(e) 12(1)(b) 6. OP7 Cumberland House H59-H10 S21084 Cumberland House V239760 210805 Stage 4.doc Version 1.40 Page 18 7. OP9 13(2) Medication Administration Records must be filled in after staff members have administered medication. Ongoing 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 OP38 OP38 Good Practice Recommendations The premises should be assessed on a regular basis, by a fire safety adviser, to ensure all current fire safety standards are met. Fire safety training should be by a fire safety expert. Cumberland House H59-H10 S21084 Cumberland House V239760 210805 Stage 4.doc Version 1.40 Page 19 Commission for Social Care Inspection Ivy House 3 Ivy Terrace Eastbourne East Susssex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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