CARE HOMES FOR OLDER PEOPLE
Cumberland House 21 Laton Road Hastings East Sussex TN34 2ES Lead Inspector
Mrs Sally Gill Unannounced Inspection 6th December 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cumberland House DS0000021084.V270910.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cumberland House DS0000021084.V270910.R01.S.doc Version 5.0 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.V270910.R01.S.doc Version 5.0 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 21st August 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 ensuite, 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. Cumberland House DS0000021084.V270910.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place on Tuesday, 6th December 2005 between 10.00am and 2.45pm. Additional time was spent in preparation and report writing. During the inspection the Inspector spoke to six residents in company, two relatives and a health professional visiting the home. Also, she spoke to the Registered Manager and the deputy. Feedback from residents during the inspection confirmed that they are fully satisfied with their care at Cumberland House. Comments included “the staff are smashing”, “I’ve got a nice room”, “the foods nice” and “ the foods delicious”, “staff are helpful”, “Mrs Gratton is a lovely lady” and “we have no complaints whatsoever”. 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 and staff files. The Inspector accessed parts of the building including the dining room, lounge, conservatory, the office, ground floor bathroom, and second floor toilet. After discussion during the inspection those that live at Cumberland House will be referred to in this report as residents. The Inspector would like to thank both residents and staff who assisted during the inspection. As this report only covers only some of the key standards it should be read in conjunction with the previous inspection report. What the service does well:
Residents are encouraged to be as independent as possible and access the local community as much as possible. There is a commitment with good results to make the home homely for residents. Menus reflect that residents benefit from a varied, balanced and wholesome diet. Although not a choice menu alternatives are always available which Cumberland House DS0000021084.V270910.R01.S.doc Version 5.0 Page 6 residents confirmed. A kitchenette is situated on the ground floor where residents can help themselves to drinks at anytime. Both rear and front gardens are well maintained and residents confirmed used frequently by the majority of them in the right weather. Feedback from a professional spoken to demonstrated that good relationships have been developed with professionals to benefit the residents. Relatives confirmed that they are always made to feel welcome and kept fully informed about their family member. What has improved since the last inspection? What they could do better: Residents and others involved in the home must have the opportunity to feedback their views through a formal quality assurance system to ensure the home is run in the best interests of the residents. Residents and others should receive feedback in the form of the results published. Improvements to fire safety must be implemented to ensure the safety of residents. The fire safety records were not available on the day of the inspection and to ensure safety through regularly testing home must send the Commission a copy of the fire safety logbook, the Fire Safety Officer must approve the fire risk assessment, fire drills must be carried out six monthly. To ensure residents safety the handrail at the side of the toilet in the ground floor bathroom must be repaired/replaced. In the interest of hygiene the laundry floor must be readily cleanable.
Cumberland House DS0000021084.V270910.R01.S.doc Version 5.0 Page 7 The action and outcomes to complaints must be recorded to ensure that resident’s complaints are taken seriously and acted upon. To protect both residents and staff improvements are still required to the medication system in relation to recording. The safety of the system may be improved if management carried out regular audits. There must be a risk assessment in place, which is regularly reviewed in relation to one particular resident consuming alcohol, becoming disorientated and injured away from the home. To ensure resident benefit from a competent and qualified staff team the numbers of staff qualified to National Vocational Qualification (NVQ) level 2 or above must be increased. 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.V270910.R01.S.doc Version 5.0 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.V270910.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None inspected on this occasion EVIDENCE: Cumberland House DS0000021084.V270910.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9, There are shortfalls in the medication recording systems, which could pose a risk to residents. EVIDENCE: A local chemist supplies the medication in blister packs. The Inspector viewed the MAR charts, which showed that medication had been administrered, and not signed for on several occasions. This had also been highlighted at the previous inspection. Management should undertake audits, which include observations of administration to ensure that all staff are following the homes medication procedure. The Registered Manager felt that this was a result of new staff under her supervision however clearly some staff do not understand the importance of following the homes medication correctly and this area of poor practice must be addressed. Further areas of concern on the MAR charts were discussed including using stickers and pen to cover original information, handwritten entries not signed, dated and witnessed, not all medication was logged into the home correctly with a signature and the quantity, sections used for one than one medication.
Cumberland House DS0000021084.V270910.R01.S.doc Version 5.0 Page 11 These areas must be addressed by the home and it is recommended that the home obtain a copy of the Royal Pharmaceutical Society’s “The Administration and Control of Medicines in Care Homes”. The requirement to develop a risk assessment for one particular resident was discussed and this remains outstanding. Options for the structure of the risk assessment were discussed and the Registered Manager agreed to have this in place within one week. Cumberland House DS0000021084.V270910.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 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 confirmed hat they were able to bring in their own possessions. 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. Two relatives and a health professional were visiting on the day of the inspection and all confirmed that they are always made to feel welcome and had only positive comments regarding the staff and home.
Cumberland House DS0000021084.V270910.R01.S.doc Version 5.0 Page 13 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 Residents felt that if they had any issues (which they don’t) they would be sorted out. Minor improvements must be made to the complaint records. Residents are protected from abuse. EVIDENCE: The Inspector viewed the complaints book, which had two complaints, recorded since the last inspection. The last complaint made in October did not have the action taken and the outcome recorded and this was discussed with the Registered Manager. The complaint was upheld and to evidence that this was taken seriously the action taken and outcome must be recorded. The home has an adult protection and whistle blowing policy in place to protect residents from abuse. No accidents had been recorded since the last inspection. Records of residents savings and personal allowances where checks and found to be in order. Cumberland House DS0000021084.V270910.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 26 Residents live in a comfortable, homely and well-maintained environment. Improvements are required to ensure residents safety and a hygienic environment. EVIDENCE: The home and garden are generally well maintained, clean, comfortable and homely. Areas requiring attention include the loose handrail in the ground floor bathroom and the laundry floor must be readily cleanable. On the day of the inspection the home was warm and clean. The fire safety logbook was not available for inspection therefore a copy must be sent to the Commission. The Fire Safety Officer must approve the fire risk assessment and this is outstanding from the previous inspection as is the requirement to have two fire drills per year. The EHO has visited and reflected in his feedback that good improvements within the home.
Cumberland House DS0000021084.V270910.R01.S.doc Version 5.0 Page 15 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, Resident’s needs are met by an experienced staff team although not qualified in sufficient numbers. A robust recruitment process protects residents. EVIDENCE: The Inspector was advised that four carers 8am – 2pm, two carers 2pm – 9pm and one wake night carer 8pm – 8am staff the home. This is in addition to the Registered Manager, a cook 9.30am – 2pm (although sick on the day of the inspection therefore covered by care staff) and a domestic 8am – 2pm. At times there are additional numbers to these and on the day of the inspection there were five carers on duty in the morning. All staff are over 21 and most have a wealth of experience. The numbers of NVQ qualified staff was discussed and at present is three on going and one completed. However this is one short of the 50 target. Staff files evidenced a robust recruitment procedure is in place. The home is aware of the changes to the NTO standards and these were discussed particularly in relation to providing evidence to take to future employers of competency. Cumberland House DS0000021084.V270910.R01.S.doc Version 5.0 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): 33, 35, 37 A formal quality assurance system should be implement to ensure resident’s views underpin the homes development. Resident’s financial interests are safeguarded. Minor improvements are required to records. EVIDENCE: Although the Registered Manager feels that residents have the opportunity to view their opinions on a day-to-day basis about the home there is no formal quality assurance system in place. Requirement made at previous inspection. The benefits and ways of achieving of this were discussed. The Inspector checked the balances and records of resident’s savings/personal allowance, which appeared in order. A requirement was made for those that undertake staff supervision should be relevantly trained. Only the Registered Manager undertakes staff supervision
Cumberland House DS0000021084.V270910.R01.S.doc Version 5.0 Page 17 and she has now completed her NVQ level 4 in care, one of the units of competency was managing teams and individuals. There are minor improvements to be made to records including medication and complaints. See previous standards. Cumberland House DS0000021084.V270910.R01.S.doc Version 5.0 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 3 X 2 X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X 2 X Cumberland House DS0000021084.V270910.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 12(1)(b) Requirement 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 (brought forward from previous inspection) Medication Administration Records must be filled in after staff members have administered medication (brought forward from previous inspection) The home must have a safe system for all recording within the medication system All complaints must have recorded actions and outcomes Send to the Commission a copy of the fire safety logbook Repair/replace (make safe) the handrail in the bathroom That a minimum of 50 if care staff are trained to NVQ level 2 or equivalent by 2005 (brought
DS0000021084.V270910.R01.S.doc Timescale for action 12/12/05 2 OP9 13(2) 07/12/05 3 4 5 6 7 OP37OP9 OP37OP16 OP37OP38 OP19 OP22 OP28 13(2) 17 Schedule 4 23(4), 17 Schedule 4 23(2) b 13(4) a 19(5)(b) 19/12/05 07/12/05 12/12/05 06/01/06 31/12/05 Cumberland House Version 5.0 Page 20 8 OP33 24(a)(b) (2) 9 OP33 24(a)(b) (2) 10 OP38 23(4)(3)& 23(4)(e) forward from three previous inspections) Quality assurance systems should be set in place to receive the views of service users and their families and other stakeholders (brought forward from two previous inspections) The results of any quality assurance surveys should be published (brought forward from two previous inspections) Regular fire drills must be held at least twice a year and be recorded (brought forward from two previous inspections) 31/03/06 30/04/06 13/12/05 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 3 4 5 Refer to Standard OP9 OP9 OP38OP19 OP26 OP38 Good Practice Recommendations Obtain a copy of the Royal Pharmaceutical Society’s “The Administration and Control of Medicines in Care Homes” Carry out audits on the homes medication system including observations of administration The Fire Safety Officer must approve the fire risk assessment The laundry floor must be readily cleanable The premises should be assessed on a regular basis, by a fire safety adviser, to ensure all current fire safety standards are met (outstanding from previous inspection) Cumberland House DS0000021084.V270910.R01.S.doc Version 5.0 Page 21 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
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