CARE HOMES FOR OLDER PEOPLE
Cumberland House 21 Laton Road Hastings East Sussex TN34 2ES Lead Inspector
Alexis Reilly Key Unannounced Inspection 30th April 2006 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.V290797.R01.S.doc Version 5.1 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.V290797.R01.S.doc Version 5.1 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.V290797.R01.S.doc Version 5.1 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 6th December 2005 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 suit to those with mobility problems. The home has a large well-maintained rear garden with seating and lawn area for residents to enjoy and front garden also has seating for residents. Ample car parking is available within the street outside. The building is located a 15 minute walk from the town centre and a shorter walk to the nearest shops. The home currently has 16 residents. The services range of fees are from £322.40 to £366.08 per week. The providers email address is ‘linda@chouse21.fsnet.co.uk Cumberland House DS0000021084.V290797.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which commenced at 10am lasting for 4 hours. Additional time was spent in preparation, and in telephone discussion with mental health professionals who have access to the home and report writing. During the inspection the Inspector spoke to four residents. Two members of staff were interviewed and the inspector also met with the Registered Manager. The Inspector examined various records including residents’ savings/personal allowance and cash balances, Medication Administration Record (MAR) charts, adult protection and whistle blowing procedure, the complaints log, and the accident book. Menus, staff files including supervision staff training and recruitment, health and safety records, the quality assurance systems and four care plans were also examined. The Inspector accessed parts of the building including the dining room, lounge, conservatory, the office, second floor toilet, and the majority of the residents bedrooms. What the service does well: What has improved since the last inspection?
Cumberland House DS0000021084.V290797.R01.S.doc Version 5.1 Page 6 Copies of the Quality Assurance forms were viewed during the inspection and were found to be in order, the results of the Quality Assurance surveys were analysed and were published in March 2006, a copy of which is on the file The service has obtained a copy of the Royal Pharmaceutical Societies, The Administration and Control of Medicines in Care Homes. An audit of the medication system including observations of administration has also been carried out. This ensures that the outcome for residents in the home is good, and that their care is under continual monitoring. What they could do better: 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 DS0000021084.V290797.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cumberland House DS0000021084.V290797.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. The service ensures it has gained the relevant background information for a resident prior to offering them a place in the service. EVIDENCE: The service has had no new residents placed since the last inspection. However the care plans and admission documents for previously admitted resident to the home, were examined and were found to be in good order. 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 DS0000021084.V290797.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. Service users are not fully protected by the homes policies and procedures with regard to medication. EVIDENCE: Issues raised with regard to the administration of medication raised at the last inspection have been addressed and have improved, however gaps were still present in the Medical Administration Record sheets. An example list of staff signatures is now present in the Medical Administration Records. The service has obtained a copy of the Royal Pharmaceutical Societies The Administration and Control of Medicines in Care Homes, and has carried out an audit of the medication system including observing staff administer medication. 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
Cumberland House DS0000021084.V290797.R01.S.doc Version 5.1 Page 10 procedures for meal times. Care Plans identified ongoing needs, risk assessments, and strengths and weaknesses. A requirement was made at the last inspection to update the risk assessment for one particular resident. This was examined on the day of the inspection and was found to be in order. Weight charts had been completed for residents and history of falls where recorded appropriately. 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 present. Cumberland House DS0000021084.V290797.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to this service. Residents have opportunities for a variety of appropriate leisure activities, are able to access the wider community and maintain good links with friends and families. Daily routines are very flexible with residents able to exercise choice. EVIDENCE: The home offers a variety of activities on a weekly basis including pottery, aromatherapy, tai chi and music therapy. Resident confirmed that these activities are very much enjoyed. One 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 and the radio and play cards, some in the communal areas and others preferring their own rooms. Residents are encouraged to handle their own finances and/or their personal allowances. Advocacy information is displayed and available. Several residents access the wider community on a regular basis using the local shops, public houses and meeting friends and family. Menus were varied and residents confirmed they enjoyed the food.
Cumberland House DS0000021084.V290797.R01.S.doc Version 5.1 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 the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. The service has an accessible complaints procedure in place, and service users feel their complaints are taken seriously and acted upon. Service users are protected from abuse by the policies in the service. EVIDENCE: The home has an adult protection and whistle blowing policy in place to protect residents from abuse. Staff are aware of these and polices are available in the staff office. Records of residents savings and personal allowances where checked and found to be in order. Cumberland House DS0000021084.V290797.R01.S.doc Version 5.1 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 the following standard(s): 19,22 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. Residents live in a comfortable, homely and well-maintained environment. Improvements have been made since the last inspection to ensure residents safety and a hygienic environment. EVIDENCE: The home and garden are generally well maintained, clean, comfortable and homely. Improvements have been made since the last inspection, these are the loose handrail in the ground floor bathroom has been fixed and the laundry floor is due to be replaced. On the day of the inspection the home was bright and clean. Requirements in regard to fire safety have been met these were that the fire safety logbook is available for inspection and that the Fire Safety Officer must approve the fire risk assessment. A further requirement that two fire drills per year are carried out and recorded have also been met.
Cumberland House DS0000021084.V290797.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. Residents’ needs are meet by suitably experienced staff however these are not qualified to NVQ level 2 in sufficient numbers. EVIDENCE: On the day of the unannounced inspection the service had on the morning duty 1 carer from 7am – 11am, 1 carer from 8am – 2pm, and 1 carer from 9am – 2pm. In the afternoon duty the service had 1 carer on from 2pm – 8pm, and 1 from 2pm – 9pm. One member of staff covers the night duty. The service ensures at least 1 senior staff member is on duty on each shift, in addition to this the Registered Manager visits the service every day. The manager is currently working two night duties each week, as the home as a vacancy for a sleep in member of staff. A domestic staff member is employed from 8am – 2pm from Monday to Friday inclusive. Two staff members have completed the NVQ level 2. The following courses have been completed by individuals of the staff team, an ‘activity organising course with age concern, health promotion course, anxiety and depression day courses, challenging behaviour, bereavement & counselling course, and a alcohol basic awareness course. All staff members last September have carried out food hygiene training. The Registered Manager must continue to ensure that staff receive training in mental health which is applicable to the client group placed within the service.
Cumberland House DS0000021084.V290797.R01.S.doc Version 5.1 Page 15 This will ensure that the residents placed receive the best possible care, by suitably trained staff. The service has had one staff member employed since the last inspection the Registered Manager assured the inspector that two written references were in place and a POVA first was completed prior to employment in the home. The employment file for this individual was not available for inspection on the day, however the inspector requested that all staff recruitment records be available at all times for inspection. Cumberland House DS0000021084.V290797.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. The service is run and managed sufficiently and run in the best interests of the service users with their rights and best interests protected. EVIDENCE: Service users views underpin this judgement. Quotes received on the day of the inspection ranged from ‘couldn’t ask for a better place’, ‘food is beautiful’. ‘I like it here can come and go as I want, they help me in the bath, the food is good and if I am unhappy I can talk to staff’. The service has introduced a formal quality assurance system to ensure the resident’s views underpin the homes development. Supervision is carried out once every two months for care staff, and if necessary will be increased to monthly supervision.
Cumberland House DS0000021084.V290797.R01.S.doc Version 5.1 Page 17 Copies of the Quality Assurance forms were viewed during the inspection and were found to be in order, the results of the QA surveys were analysed and were published in March 2006, a copy of which is on the file. Records were safely stored and recording was accurate, recording on MAR sheets had improved however gaps were still evident. Complaints were recorded appropriately and outcomes listed. The service has in place a ‘Code of Rights for residents’, and a ‘Equal Opportunities Statement’, diversity is seen as a positive asset. There is also in place an Equal Opportunities and Fare Treatment Policy for Service Users and Staff, along with a ‘Personal Relationships and Sexuality Policy, and a policy for dignity autonomy and rights. The patient host was last examined ion 28/10/05. The gas safety record was dated 9/6/05. The service has a fire maintenance certificate which shows fire extinguishers and emergency lighting had been maintained and tested this was dated 7/10/2005. A fire consultant carried out a fire prevention and protection fire risk assessment on the 23/2/2006. All radiators in the service are guarded. The risk assessment is due for review in April 2006. Fire alarm logs show that they are tested weekly, the emergency lighting was last logged as checked in February 2006, and the last recorded fire drill was carried out on 23/2/20006. The fire safety officer has approved the fire risk assessment. Cumberland House DS0000021084.V290797.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 2 Cumberland House DS0000021084.V290797.R01.S.doc Version 5.1 Page 19 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 (brought forward from four previous inspections) The recommendations from the fire risk assessment carried out on 23/2/2006 are completed. Medication Administration Records must be filled in after staff members have administered medication (brought forward from previous inspection) Timescale for action 01/10/06 2. OP38 23(4)(3)& 23(4)(e) 13(2) 01/07/06 3. OP9 30/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP26 Good Practice Recommendations The laundry floor must be readily cleanable
DS0000021084.V290797.R01.S.doc Version 5.1 Page 20 Cumberland House Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cumberland House DS0000021084.V290797.R01.S.doc Version 5.1 Page 21 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
