Inspecting for better lives Random inspection report
Care homes for older people
Name: Address: Cumbria House 84/86 Shorncliffe Road Folkestone Kent CT20 2PG The quality rating for this care home is: The rating was made on: three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Penny McMullan Date: 2 8 0 1 2 0 0 9 Information about the care home
Name of care home: Address: Cumbria House 84/86 Shorncliffe Road Folkestone Kent CT20 2PG 01303254019 Telephone number: Fax number: Email address: Provider web address: cumbriahouse@ashwoodhealthcare.co.uk Name of registered provider(s): Type of registration: Number of places registered: Cumbria House care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category 0 Over 65 32 Conditions of registration: The registered person may provide the following categorY of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) The maximum number of service users to be accommodated is 32 Date of last inspection Brief description of the care home Cumbria House is a detached property in Folkestone situated within easy walking distance of local amenities and public transport. A major refurbishment has been completed with improved accommodation, such as en suite facilities, and a safer and more comfortable environment. All rooms are now being used for single accommodation and there is a shaft lift enabling access to services users to all parts of the home. There are communal lounges and a separate dining room. There are mature, well maintained gardens which have ramps for easy access for wheelchair Care Homes for Older People
Page 2 of 11 users. There is a large patio area where service users can sit and relax. Up to date fees can be obtained from the home. Care Homes for Older People Page 3 of 11 What we found:
This random inspection focused on three outcome areas, Health and Personal Care, Complaints and Protection and Staffing. An unannounced visit was made to the home on 28 January 2009, residents, relatives and staff were spoken to and various documents were viewed. The Deputy Manager assisted throughout the visit and feedback was also given to the Registered Manager on 29 January 2009. Health and Personal Care The care of two people was tracked to help gain evidence as to what its like to receive a service from the home. In some areas the plans contained good information of how to care for the individual, however there are examples where improvements need to be made. Sometimes the detail in the care plan is not clear to ensure that the person receives the care they need, taking into account their health and personal preferences. For example, assistance with personal care and assistance when mobilising does not give staff a clear guideline of how this should be carried out, and the home needs to record just what assistance means to the individual. The moving and handling risk assessments also contain the word assistance and lack specific detail of how to move a person. They need to be improved to make sure that staff have a clear written record of how to move people safely. There has been a high number of residents invoved in a falls during the last two months. The home has completed the accident forms and summarised the information with action taken. However, this information has not been consistently recorded and updated in the care plans. For example when a resident fell several times in one month, the moving and handling risk assessment was not updated. The action taken was recorded on the summarised account of the accident form but not in the care plan. In addition to this the record of any health care visits, GP or District Nurse, had also not been updated. The care plan needs to be consistently updated to make sure the staff are clear of what changes have been made to ensure they can meet the residents needs. From talking to the residents and staff it is evident that the home are ensuring health care needs are being met, however, this is not reflected in the care plans. Care plans need to be up to date and include full details of individual care so that staff can feel confident that the care plan will have clear guidelines of how they can meet individual needs. Residents spoken to confirm the staff look after them well if they fall or are poorly and they told us that they see the Doctor, District Nurse and go to hospital appointments. Improvements are required when staff are completing the daily contact sheets. In two cases the information recorded could not be easily read and abbreviations such as W and D for wash and dress is not acceptable. The use of assisted with personal care, appears ok, and all care given do not give a clear picture of what care has been provided. Carers should also sign their full name to identify who is responsible when providing personal care. The Registered Manager told us that the issue of completing the daily contact sheets has been raised previously and all staff will now be reminded of how to complete the Care Homes for Older People Page 4 of 11 sheets. Although there is some evidence that residents have been involved in completing the care plan, no one has signed their care plan to say they agree with the contents. Some have signed risk assessments for medication. The home needs to involve the residents, their representatives or advocates in care planning to ensure that all personal preferences and choices are recorded. The plans need to be more person centered with detailed information, which has been agreed by the individual. A residents comment: I know they write about me but do not know what is in the care plan, I know they write in it when things happen. A requirement will be made in this report to cover all of the above issues. Complaints and Protection The Home has a complaints policy in place, which is displayed in the hallway. The complaints folder contained one complaint since the last inspection, which was actioned within appropriate timescales. Residents spoken to confirm they do not have any complaints and feel confident that their complaints will be listened to. Resident comments: I have no complaints but would say if I needed to. Yes I know how to complain, I have raised a concern in the past and the Manager sorted it out very quickly. Staff discussed the importance of safeguarding and demonstrated their awareness of making the residents safe. The majority of staff have received The Protection of Vulnerable Adult training and there are additional courses booked for February. The home was involved in a safeguarding alert last year, which was responded to appropriately. There are no current safeguarding issues. Staffing At the time of the inspection the Deputy Manager was managing the home, there was one Senior Carer, one carer on duty from 8 am to 2pm and one from 8 am to 11 am. In the afternoon there was one Senior Carer, one carer on duty form 2pm to 8pm and one from 4pm to 8pm. This means at times there are only two carers on duty to care for 29 residents. The Deputy Manager told us that she or the Registered Manager assist with the direct care of the residents when required. With 29 residents, five of which need more than one carer to assist them and at times a minimum of two staff, leaves the other residents at risk of not having their care needs met. There is no laundry person therefore the care staff are also responsible for the daily laundering and putting the clothes away. The layout of the building is over a large area and when staff are putting laundry away in residents rooms, this can leave the home with only one carer available in the lounge to meet residents needs. Daily staff also includes two domestics, a cook, kitchen assistance and a maintenance person. At the previous inspection a recommendation was given to review the staffing levels. As a result the home introduced two additional shifts in the morning and afternoon. Information from the January rota shows that this additional shift was only implemented once for two weeks, and twice for two weeks. In addition to this there Care Homes for Older People Page 5 of 11 was two weekend days when there were only two staff on duty for the full shift and one covering the split shift. The Registered Manager says when this occurs she or the deputy is on hand to cover if required. There have been a considerable number of resident falls and slips in the last two months. Action recorded on the accident summary indicates that residents need to call and wait for staff, this indicates that they try to move before staff arrive to assist them. Whilst this may be the case increased staffing levels would minimise the risk of falls as response times would be quicker. A requirement will be made in this report to review staffing levels to ensure that at all times there is sufficient care staff on duty to meet the needs of the residents. When asked if there is enough staff on duty two relatives comments: Overall my relative is happy here and the staff are fine, sometimes I think there could be more on duty, but in general it is OK. There seems less staff on at weekend, they are skeletal but they seem to cope. The Registered Manager told us that she would be advertising for one full time and one part time carer to address the staffing levels. In addition there will also be a dedicated Activities Co-ordinator who will be employed for 24 hours per week. Over fifty per cent of the care staff have achieved or are completing the NVQ level 2 or 3. We looked at two staff files, which contained the relevant documentation to employ staff safely. This included the appropriate checks such as Protection of Vulnerable Adults (POVA) First and Criminal Record Bureau (CRB) checks. This ensures that staff are safe to provide care to the residents. Although there are shortfalls in the mandatory training the home has a training programme in place to address these issues. The home needs to ensure that this is ongoing to provide all staff with the training they need to meet residents needs. The home has an in house induction programme, which includes shadowing, and competency based evidence of completion. What the care home does well: What they could do better:
Care plans need to be reviewed to provide more detail of how to care for the individual person. The residents need to be more involved and participate in the review of their plan. Improvements are required when recording in the daily contact sheets. Risk assessments require further detail to provide staff with written guidance of how to move people safely. Review staffing levels to ensure that residents care needs are fully met. Care Homes for Older People
Page 6 of 11 The people who use the service comment: The staff are quite good but there is not enough on duty, they do their best but sometimes take a while to come. A visitor comments: Overall I think the home is OK, however, staffing levels could be improved. Staff feedback is as follows: Staff struggle especially in the morning, it is a shame we have no time to sit and socialise with the residents as we are too busy. This is not a reflection on the care as we make sure we give everyone personal care. Mainly there is enough staff on duty, it does make it a lot easier when there is four on in the morning and afternoon. We cope and I am quite happy. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 11 Requirements and recommendations from this inspection
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans and risk 30/04/2009 assessments require further detail to ensure residents needs are met. The plans, including moving and handling risk assessments, need to be kept under review in consultation with the person. Improvements are required on the daily contact sheets to provide detail of the care provided. The care plans need to be more person centered to ensure that the individual needs are identified and met. Moving and handling risk assessments require to be reviewed when individual needs change and written guidelines put in place to enable staff to move people safely. Daily contact sheets need to provide clear details of the persons health and welfare to enable staff to monitor the care of the individual. 2 27 18 The Registered Provider needs to make sure that there are sufficient numbers 28/02/2009 Care Homes for Older People Page 9 of 11 of staff working at the home at all times. To make sure that there is enough staff on duty to meet the health, welfare and individual needs of the people who live there. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 10 of 11 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 11 of 11 - 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!
