Inspection on 15/02/07 for Cymar House

This inspection was carried out on 15th February 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cymar House 17/01/06

Cymar House 09/08/05

Cymar House 28/02/05

Cymar House 04/08/04

Cymar House 10/03/04

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Abbey The

Snydale Care Home

Whiteley House

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Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

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

CARE HOMES FOR OLDER PEOPLE Cymar House 113 Pontefract Road Glasshoughton West Yorks WF10 4BW Lead Inspector Susan Vardaxi Unannounced Inspection 15th February 2007 08:55 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 Cymar House DS0000006176.V314217.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. Cymar House DS0000006176.V314217.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cymar House Address 113 Pontefract Road Glasshoughton West Yorks WF10 4BW 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) 01977 552018 01977 603038 cymar@daisyconnect.com Cymar Care Homes Limited Ms Jillian Gill Care Home 22 Category(ies) of Dementia - over 65 years of age (22), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (22), Old age, not falling within any other category (22) Cymar House DS0000006176.V314217.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th January 2006 Brief Description of the Service: Cymar House provides residential care for 22 older people over the age of 65 years, some whom may have dementia type illnesses or mental health disorders. The home is situated in a residential part of Glasshoughton on the outskirts of Castleford. It is on the main bus route and close to all amenities including shops, post office, supermarkets and public houses. Set back in its own grounds there is car parking to the front of the home and lawns to the front and rear of the building. The large hallway at the front entrance leads into the dining room and kitchen to the left, and a large lounge to the right of the hallway. a small quiet lounge is available for service users at the rear of the building. A shaft lift is available for service users and bedrooms are located on the upper and ground floor of the home. The main provision of bedrooms is for single occupancy, however there are two large bedrooms that are available for service users who wish to share. The weekly fees for the service in February 2007 were £359. Hairdressing and chiropody are charged in addition to the fees. Also a hourly charge for service users needing escorts to hospital at times when relatives are unable to escort would be charged. The home makes people aware of the service provided and of the Commission for Social Care and Inspection in the service users guide and inspection reports which are on display on the reception room desk. Cymar House DS0000006176.V314217.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 visit, which occurred on 15th February 2007 commencing at 9am and extended over eight hours. The visit included talks with some service users’, two visitors; some care staff on duty, the manager and deputy manager. Some records were checked and a walk round the premises completed. Some comment cards were sent to some service users, relatives, social and health care providers seeking their views of the service. Six relatives, one service user and a GP have completed cards. Two incidents had occurred at the home since the last regulatory visit, one of which was service user on service user, which the manager had referred appropriately under the local authority’s interagency safeguarding procedures What the service does well: What has improved since the last inspection? Cymar House DS0000006176.V314217.R01.S.doc Version 5.2 Page 6 Some training had been provided including, medication, health and safety and manual handling completed by external providers. Records of hot water temperatures and some re decoration and tiling had occurred. 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. The summary of this inspection report can be made available in other formats on request. Cymar House DS0000006176.V314217.R01.S.doc Version 5.2 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 Cymar House DS0000006176.V314217.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission arrangements are satisfactory. Intermediate care is not provided at the home. EVIDENCE: Service users records checked showed that pre admission assessments had been completed. A visitor spoken with said that they had read the CSCI inspection report prior to visiting the home. They said the manager had provided them with all necessary information in respect of the service prior to their relative being admitted. A copy of the service user guide and the inspection report are available for visitors on the desk in the entrance to the home. Cymar House DS0000006176.V314217.R01.S.doc Version 5.2 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. 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 visit to this service. Service users’ health, personal and social care needs are set out in an individual plan of care and arrangements for providing health care are satisfactory. However, the medication administration records examined, considered against the balance of drugs, did not always confirm that medication has been given as prescribed. EVIDENCE: Service users’ care plans seen had been produced from needs assessments. The action to be taken by staff in the event of aggressive behaviour occurring was recorded. The care plans seen had been reviewed and updated. Risk assessments seen had been completed appropriately. Three service users who have developed pressure sores are in the care of the district nurses. Pressure relieving equipment had been provided in the lounges and service users bedrooms. A district nurse spoken with after the visit Cymar House DS0000006176.V314217.R01.S.doc Version 5.2 Page 10 confirmed that staff follow the guidance the nurses give in respect of pressure area care. She said one service user had developed a pressure sore when they had not been at the home and one service user’s small pressure sore had worsened during a time when they had not been at the home. One relative’s comment card received stated” they ring me immediately if there are any medical problems or concerns” the home is excellent, they are kept informed of GP and other health professionals visits and kept up to date of the service user’s condition. A GPs comments were positive and stated in respect of what the service does well as the “satisfactory care of residents” Service users’ weight had been recorded and the GP had been informed when staff had observed changes in one service user’s health. GP and health professionals’ visits had been recorded. A visitor spoken with said their relative had put weight on since being admitted to the home and they have no concerns, as they know their relative “is safe”. The action taken by staff to meets service users assessed needs had not always been written in the daily records. Records of accidents had been kept and where necessary reported as required under the RIDDOR regulations. Information provided on the pre inspection questionnaire showed a sixteen week medication training course was being provided for some staff. A member of staff said they were doing the course. The home has auditing procedures in place and the manager who assisted throughout with the checking process provided evidence of this. Six service users’ medication records were checked; the medication trolley was seen to be secured to the wall. The contents were stored safely and all medications stored in boxes were easily identifiable. Eye drops were appropriately labelled and the dates of opening recorded. Hand written entries seen on one medication record had been signed and countersigned by staff. The medication cycle had commenced four days prior to the visit, generally most medications checked had been signed as given and the medication in stock balanced. Two examples were found of medication discrepancy. One service user’s medication sheet, for a medication to be given at night, had not been signed on three consecutive occasions however the tablets were not in the blister Cymar House DS0000006176.V314217.R01.S.doc Version 5.2 Page 11 pack. The signatures recorded on another/one service user’s records against the number of tablets in stock indicated that the medication had not been given on two occasions. Some medication issues had also been identified at a previous inspection. Staff were observed assisting service users throughout the visit and no incidence occurred that could have affected service users’ privacy and dignity. Some friendly interaction between some service users regarding the delivery of personal care was noted and a member of staff discouraged the comments at the time. The effect that this friendly interaction could have in relation to who and how personal care tasks are delivered was discussed with the manager. She said she would review the homes intimate care policy to ensure service users and staff are fully protected when providing personal care. Service users spoken with looked well groomed and comfortable, their clothes were well laundered and personal hygiene needs attended to. Cymar House DS0000006176.V314217.R01.S.doc Version 5.2 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. 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 visit to this service. Some activities and entertainment is provided, service users are encouraged to participate however their wishes not to be involved are respected. Service users are able to maintain contact with families, friends and the local community as they wish and are generally satisfied with the care provided. Service users are satisfied with their meals. EVIDENCE: The views of service users on the activities provided by the home varied. Two service users said they played cards. A record of individual service user’s activities are kept and showed bingo, and entertainers had visited. One comment card received stated their relatives preference not to join in activities was respected however encouragement given. The interaction between some service users was observed and they appeared to enjoy each other’s company. A service user who had recently been admitted to the home said they had made some friends. Cymar House DS0000006176.V314217.R01.S.doc Version 5.2 Page 13 A regular visitor said the manager keeps them up to date with all aspect of their relative’s care. A comment made by a relative, on a comment card, stated that their relatives’ quality of life had improved since their admission to the home. A service user said the local clergy visit the home to give Communion. Some records seen showed the manager had discussed advocacy arrangements at the point of admission to ensure they are appropriately supported. A member of staff was observed informing service users of the choices from the menu, which was Cornish pasty or shepherds pie and vegetables, followed by pineapple sponge and custard or rice pudding. Service users spoken with said they get plenty to eat and the food is good. A relative’s comment received stated the “meals are excellent”. However, since the visit a relative has contacted raising concerns about the amount of food served and this has been passed to the providers for their investigation. The inspector joined some service users for lunch and sampled the shepherds’ pie. It was cooked to a good standard and was served with carrots and cabbage. It was observed that the main meal was served on small plates, the manager said that service users had been “over faced” when meals were served on large plates as much of the meal was being left. It was observed that all service users did not finish the meal. The member of staff was observed asking service users if they had finished the meal and offering encouragement to eat the meal before removing the plates from the table. Staff assisted service users appropriately, independence in eating the meal was respected however assistance given where needed. Cymar House DS0000006176.V314217.R01.S.doc Version 5.2 Page 14 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): 16,17,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes complaints and safeguarding policies ensure that complaints are dealt with and service users are protected. EVIDENCE: Visitors spoken with said they were aware of the homes complaints procedure and were confident they could go to the manager. The complaint records were seen which the manager had developed to record any issues that have been brought to her attention by staff or relatives. The homes survey questionnaires completed by service users evidenced that the manager follows up and records any issues that service users are not happy with. The manager said all service users have the opportunity to vote and this is recorded in their care plans. Since the last visit the manager had appropriately reported two incidents that had occurred at the home as required under Wakefield Metropolitan District Council Multi Agency Safeguarding Procedures. One incident in respect of two service users was resolved, one incident is currently being dealt with by the manager under the home disciplinary procedures. There had been a delay in one incident being brought to the manager’s attention. Since then the manager Cymar House DS0000006176.V314217.R01.S.doc Version 5.2 Page 15 did provide written confirmation to the Commission of the action she had taken in respect of the homes Whistleblowing policy, to prevent delays in reporting incidences in the future. A new member of staff confirmed they had been given a copy of the homes Whistleblowing policy when they started work. A visitor who lives away said they knew their relative was “safe here.” Cymar House DS0000006176.V314217.R01.S.doc Version 5.2 Page 16 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): 19,22,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a well-maintained and comfortable environment for service users to live in. EVIDENCE: Some routine maintenance work was being completed in the home at the time of the visit. The maintenance person adjusted the door closures on fire doors immediately when he was aware that the doors were not closing fully into the doorjambs. The communal areas were light, well decorated and clean, service users looked comfortable and relaxed. Some re decoration had occurred since the last visit. Cymar House DS0000006176.V314217.R01.S.doc Version 5.2 Page 17 Service users’ bedrooms seen were clean and tidy and personalised with family photographs and ornaments and pictures. The bed linen had been laundered to a good standard. Some hot running water temperatures were tested, and found safe, with delivery around 43 degrees centigrade. Emergency call cord extensions had been provided in some bedrooms seen to provide easy access to assistance if needed. The manager said she would risk assess the arrangements for storing commode chairs and commode pots. She said these were taken from service users’ bedrooms when service users were in the communal rooms so that their privacy and dignity is maintained when they receive visitors. Cymar House DS0000006176.V314217.R01.S.doc Version 5.2 Page 18 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. Staffing levels need to be kept under review to ensure that planned staffing levels are maintained to meet the needs of service users. EVIDENCE: The manager had informed the Commission, prior to the visit, that she was undertaking some of the cook’s duties due to a vacancy occurring at short notice. The manager said she also helps with the provision of personal care when needed. The manager said that she always tries to ensure that there are four carers on duty. It was observed that most service users require some assistance from staff. The information on the pre inspection questionnaire shows that 10 of the 22 service users required two staff to assist them. It was observed at the visit that some service users required the hoist to enable transfer from chair to chair necessitating two staff assist. On the morning of the visit the manager was on duty along with the deputy manager and an experienced carer. A member of staff who had only worked at the home for one week was also on duty. The deputy manager said there “are enough staff on duty. The new member of staff on duty said that as part of her Cymar House DS0000006176.V314217.R01.S.doc Version 5.2 Page 19 induction she was “shadowing staff and observing manual handling practices including using the hoist. A carer said they “get by”. The deputy manager said when she completes staff rosters she always makes sure someone experienced works with new staff”. Information on the pre inspection questionnaire shows that 75 of care staff have NVQ level 2 or above. The deputy manager said she has NVQ level 4 in care and is nearly ready to finish the training for the registered managers award. Records seen for two staff recruited since the last visit showed that interviews had occurred, application forms had been completed, two satisfactory references had been obtained, job descriptions and contracts provided. A CRB and POVA check had been completed for one member of staff prior to them commencing working at the home. The manager could only provide evidence that a CRB check which was dated after the date a member of staff had started work. The manager said the POVA first check had been made however was not able to locate written confirmation of this. Positively a member of staff spoken with said that they had attended some training courses including manual handling, medication and dementia. Information provided on the pre inspection questionnaire showed infection control training had been provided, first aid, food hygiene, fire and abuse training was planned. A training matrix seen at the visit confirmed this. Cymar House DS0000006176.V314217.R01.S.doc Version 5.2 Page 20 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): 31,33,35.38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management time has been reduced by the manager covering for staff and this needs to be reviewed, as does the undertaking of the monthly provider visits, to ensure the home continues to run well. EVIDENCE: The manager has the experience and qualification required to manage the home. She said she has assisted care staff in the delivery of personal care and cooks duties, as well as completing her management duties, as two care staff vacancies have occurred and have affected the roster. In the short term staffing levels have not been found to have affected the management of the home, but this may not be sustainable. A relative’s Cymar House DS0000006176.V314217.R01.S.doc Version 5.2 Page 21 comments made at the visit included that the manager had kept them up to date and given support when needed. The minutes of staff and service users meetings seen showed that they provide opportunities for airing views and also being kept up to date of events concerning the home. Some questionnaires completed as part of the home quality assurance programme were seen. The manager had audited these and addressed any issues service users had raised with them. Of concern was that there were no records to confirm that the registered person’s monthly-unannounced visits had occurred since before the last regulatory visit. The manager said these visits, which focus on the care and well being of service users and staff, had not occurred. The Commission had been notified that this was due to illness and adequate alternative arrangements had not been made. Positively various record checks found systems running well. Records of some service users’ monies held by the home for hairdressing, chiropody etc were checked and no discrepancies found. Staff training records seen show that mandatory training and training updates are provided Records of hot running water temperature checks were seen, according to the records any issues observed had been dealt with. The manager continues to do health and safety checks around the building and records are kept. Information in respect of the maintenance and system checks showed that fire drills and a fire lecture had occurred, tests for legionnella are completed weekly and the lift and bath hoists serviced. Fire training has been provided; the manager said night staff are involved in fire drills. Cymar House DS0000006176.V314217.R01.S.doc Version 5.2 Page 22 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 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 3 18 3 3 X X 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 X X 3 Cymar House DS0000006176.V314217.R01.S.doc Version 5.2 Page 23 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. 2. Standard OP9 OP29 Regulation 13(2) 19(1) Requirement The registered person must ensure that accurate records are kept of medication administered. The registered person must ensure recruitment checks are completed within the guidelines set by the Department of Health. • POVA first checks must be completed prior to staff commencing work at the home, and a record of this retained to the next inspection. A director, or suitable person employed, must carry out the monthly visits to the home and make the reports available as required and send a copy each month to the Commission. Timescale for action 31/03/07 31/03/07 3. OP33 26 31/03/07 Cymar House DS0000006176.V314217.R01.S.doc Version 5.2 Page 24 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 Refer to Standard OP7 OP10 OP27 Good Practice Recommendations The daily records should include the action taken by staff to meet service users’ assessed needs. The homes intimate care policy should be reviewed to ensure service users and staff are protected. The registered person should ensure that there are sufficient carers on duty to meet service users needs at all times. Cymar House DS0000006176.V314217.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND 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 Cymar House DS0000006176.V314217.R01.S.doc Version 5.2 Page 26 - 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. 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