Inspection on 11/10/05 for Cypress Court Nursing Home

This inspection was carried out on 11th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cypress Court Nursing Home 26/09/06

Cypress Court Nursing Home 27/04/05

Cypress Court Nursing Home 15/10/04

Cypress Court Nursing Home 19/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Cypress Court Nursing Home Broad Street Crewe Cheshire CW1 3DH Lead Inspector Anthony Cliffe Announced Inspection 11th October 2005 09:00 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 Cypress Court Nursing Home DS0000018723.V253532.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. Cypress Court Nursing Home DS0000018723.V253532.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Cypress Court Nursing Home Address Broad Street Crewe Cheshire CW1 3DH 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) 01270 588227 01270 211887 Southern Cross Healthcare (Cheshire) Limited Mrs Karen Michelle Hilditch Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60) of places Cypress Court Nursing Home DS0000018723.V253532.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 60 service users to include: * Up to 60 service users in the category of OP (old age not falling within any other category). Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidance which may be issued through the Commission for Social Care Inspection. The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 27th April 2005 2. 3. Date of last inspection Brief Description of the Service: Cypress Court Care Home is a purpose built, two storey, detached property located in a residential area close to Crewe town centre. It is operated by Southern Cross Healthcare. The home has good access to local amenities and services, including public transport. Bedrooms are on two floors with a passenger lift and staircases providing access to the first floor. There are 56 single rooms and two double rooms, all of which have en suite toilet facilities. There are two lounges and a dining room on the ground floor, and on the first floor there is a combined lounge and dining room, and another separate dining room. A nurse call system is provided in all rooms and areas used by residents. Cypress Court Nursing Home DS0000018723.V253532.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit was carried out over a period of six hours by two inspectors, (accompanied by a performance information manager) as part of the Commission for Social Care Inspection’s statutory inspection programme. 54 residents were living at the home, of which 36 were receiving nursing care and 18 receiving personal care. The inspection was carried out using a process of cross referencing the documentation of identified residents following discussion with them, and following the delivery of care and support to them. A tour of the building was conducted including a number of bedrooms and communal areas, the laundry and the kitchen. The home had a visit on 8th September from members of Cheshire County Council’s ‘Consultation and Participation Unit’. A letter sent to the home as a result of this visit stated: From the answers we received from your residents it seemed that the most important things to them were that there was a good laundry service; that a GP … attended the home; that they didn’t have to worry about their medication …; that the hairdresser and chiropodist visited; and they had a choice of food. Overall, they were more than happy with everything we asked them about. Four recommendations were made at the last inspection. Two of the recommendations, regarding medication administration, had been met. The floor in a bathroom was identified as being in need of repair. This had been done, but further repair was needed. The fourth recommendation related to staff training, and progress had been made in this regard. Some of the information contained in this report is taken from the preinspection questionnaire completed by the home manager. Cypress Court Nursing Home DS0000018723.V253532.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Three areas of flooring require attention; the kitchen, a bathroom on the ground floor, and in the laundry close to a washing machine. More investment in NVQ training is needed. New staff, and any other staff who have not already done so, should receive training relating to ‘No Secrets’ as soon as possible. Cypress Court Nursing Home DS0000018723.V253532.R01.S.doc Version 5.0 Page 7 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. Cypress Court Nursing Home DS0000018723.V253532.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 Cypress Court Nursing Home DS0000018723.V253532.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): 3 There was evidence to demonstrate that residents had been assessed before moving into the home to ensure that their needs could be met. EVIDENCE: Care documents relating to three residents were examined. Pre-admission assessment documentation had been completed for these people by the manager and senior staff from the home. The home had agreed care plans with the residents to meet their assessed needs. Two residents spoken with said staff had asked them about their care needs. One of the resident’s said ‘Saturday I moved in, I like it here. Before I moved here someone came to visit me and took information on my likes and dislikes. Staff know what food I like to eat’. Cypress Court Nursing Home DS0000018723.V253532.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): 7, 9,and 10 Each resident had a plan of care providing details of their needs. The procedures for managing medication ensures residents receive their prescribed medication. Residents are treated with privacy and respect. EVIDENCE: Evidence from care plans indicated that the health care needs of residents were being met, with reference to professional advice and treatment sought. One resident talked about the visits he receives from the physiotherapist as part of his programme of mobility. He identified that he felt confident when he could use a small side table to steady himself as opposed to using bedrails. Staff agreed to discuss this with the physiotherapist as they identified a frame would be more useful. The resident said he had agreed to the use of bedrails, as ‘It would be a matter of me falling out of bed without them as I have fits’. Cypress Court Nursing Home DS0000018723.V253532.R01.S.doc Version 5.0 Page 11 There was reference to a resident’s blood sugars being monitored at the request of the diabetic nurse to clarify why the results of monitoring were not stable. The diabetic nurse wrote to the home to thank them for their participation in this, which had established a regular pattern of unstable results, which were rectified by the advice from the diabetic nurse. Repeat prescriptions are ordered from GP surgeries and are received at the home. The prescriptions are then checked to ensure that they are as required before being sent to the pharmacy for dispensing. When a medicine administration record sheet had been handwritten, for example, for a new resident, this was double signed and the quantities of all medicines brought into the home were recorded. The list of staff signatures needs to be updated. One senior carer administers medicines when she is on duty, but when she is not on duty this is carried out by qualified nurses. Storage was satisfactory. Administration records were satisfactory. A contract for the disposal of unused medicines is in place. The disposal containers are kept in the first floor medicine room. Threes residents spoken with them confirmed that staff treat them with privacy and respect. Two residents confirmed that they were asked what their preferred from of address was. Cypress Court Nursing Home DS0000018723.V253532.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, 14 and 15. Residents are supported to make choices in their lifestyle and in meeting their social needs. Residents have a good choice of meals in pleasing surroundings. EVIDENCE: Three residents shared their experiences of living in the home. A resident said ‘I like it here the staff are helpful, I am registered blind. Staff have directed me to where I need to go. I have a list of activities but have not joined in. I am going to get the newspaper on tape and a cassette to listen to it. Staff have been very helpful they help me to dress and explain what they are doing. I can do some things for myself and they encourage me to do so. I like to get up early and staff know this. I keep to my routine, but have only been here three days and staff don’t know everything about me. The other home was busy and people were confused and interfered with your things. It’s quiet here and I like it’. Another resident said ‘I did not visit before I moved here, my wife took care of that. I like it here, I can read in my bedroom, it’s my preference and it keeps my mind active. I don’t go down to the lounge, as it’s full of old people. I am 78 and have an active mind. I have a problem with my memory and cannot remember dates but can ask staff. The staff ask me how I like to be helped and they keep and respect my independence. They help me to get dressed. I don’t have a bath as I have fits. I have not had a bath for years. Cypress Court Nursing Home DS0000018723.V253532.R01.S.doc Version 5.0 Page 13 Staff help me to have a strip wash every day, which is my choice. Staff always explain what they are doing. I receive regular visits from the physiotherapist to help with my mobility’. Another resident said ‘You’re the inspector, the fellow I talked to before. Do you remember I was moved from pillow to post. I have grasped the metal here. I know it’s not home but aside from that I think I have dropped lucky. I am staying in my room today, as I am not feeling well. I have told staff I don’t want my dinner, and they have asked if I need a visit from the doctor. The care is great and staff are great, they ask you how you like to be helped. If I was not happy I would tell my family’. Southern Cross Healthcare provides a corporate menu, which runs over a four weekly cycle. This offers a choice of two dishes at each lunch and teatime, but the manager said that in addition to this, individual requests could usually be catered for. It was noticed that the menus contain a lot of egg dishes at the evening meal, on one week for three consecutive days. Care staff complete a ‘menu selection’ form each day to inform the kitchen what each resident would like. The form also includes details of any special needs. A ‘Nutritional Intake Record’ form can be used when there is concern about a resident. The manager usually serves out the meals on three days a week and is able to monitor the quality in this way. Meals were served from the hot trolley on the first floor by the chef. Some residents collected their meals or staff took them to the table. The chef asked residents to confirm their choice of meal. Meals were presented on the plate and portion sizes were generous. Aids to assist residents eat their meals were provided along with staff assistance. The chef asked residents if they would like additional portions. As residents left the dining room they thanked staff for the meal. One resident said ‘thank you I really enjoyed that’, and several residents agreed. One relative had expressed concerned about the meal that her husband receives in the evening and has agreed with the manager that she will order his meals on a weekly basis. A resident said she enjoyed the food. She had only just moved into the home and said ‘staff know my likes and dislikes, someone visited me before I moved in and asked me about them. I like the food it’s nice I have eaten everything’. Another resident said ‘ I like the food, staff know my likes and dislikes’. Pureed meals are presented in an appetising manner. Homemade soup is offered at the evening meal. Cypress Court Nursing Home DS0000018723.V253532.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed. EVIDENCE: Cypress Court Nursing Home DS0000018723.V253532.R01.S.doc Version 5.0 Page 15 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 and 26 The maintenance of flooring in the kitchen, laundry and ground floor bathroom needs to improve to ensure residents’ and staff safety and prevent sources of food contamination. EVIDENCE: An assisted bathroom on the ground floor has an area of flooring which is lifting around the edge of the bath despite it being repaired. In the washing area of the kitchen the flooring has been previously repaired with a patch. The area around this is also lifting and tape has been used to repair this. The chef and assistant clarified that the tape has to be replaced every two days as with constant washing of the floor is looses adhesion. This also allows water contamination under the flooring, which makes the area wet and it will not dry out. Under the sink in the food preparation area the floor is lifting along a joint and this has not been repaired. This again allows water to get underneath the floor, which will not dry out and food debris can get trapped under the floor and provides a source of contamination. The records of capital expenditure to request funds to repair the flooring described the reason for repair as ‘hazardous’. The replacement of the flooring had not been agreed The kitchen Cypress Court Nursing Home DS0000018723.V253532.R01.S.doc Version 5.0 Page 16 was clean and hygienic with the chef having daily, weekly and monthly schedules of cleaning. The monitoring of food preparation and storage temperatures were recorded as required. The laundry room was clean and tidy and is equipped to meet the needs of residents. The flooring has come unstuck from in front of one of the washing machines and was collecting dust and fluff and needs to be repaired. See requirement 1. Cypress Court Nursing Home DS0000018723.V253532.R01.S.doc Version 5.0 Page 17 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 and 30. The home provides an appropriate number and skill mix of staff to meet the needs of residents. More staff need to achieve NVQ qualification in order for the home to meet the Department of Health’s target. Recruitment procedures are in place and are followed for the protection of residents. Staff receive training to enable them to perform their work but training on adult abuse needs to improve. EVIDENCE: The home employs 10 registered nurses and 28 care assistants. Examination of the current duty rota showed that there are two registered nurses on duty at all times, and care staff in sufficient numbers to meet the needs of residents. The home has not used any Agency staff in recent weeks. No staff were recorded as working an excessive number of hours on a regular basis. Cypress Court Nursing Home DS0000018723.V253532.R01.S.doc Version 5.0 Page 18 Only two of the home’s care staff have an NVQ qualification in care. Four of the staff employed as care assistants are overseas staff that are qualified as nurses in their home country. The Department of Health’s target is for 50 of care staff to achieve a qualification in care by 2005. The home will not achieve this target by 2005, but should ensure that care staff are given the opportunity, and encouraged, to work towards NVQ qualification. Staff files relating to the last three care assistants recruited, and two domestic staff, were inspected. Each file contained a completed application form, interview notes, a health declaration, two written references, a POVA first check, and evidence of a Criminal Records Bureau disclosure application. A photograph of the staff member was also on file. New staff receive induction training and records examined showed that the induction programme was being followed for recently recruited staff. The manager maintains a training matrix, which records the dates on which each member of staff last received training. The home has a moving and handling instructor and records showed that all staff, except for two nurses who work at the home on a casual basis, have received moving and handling training during the last six months. All except two staff have received basic food hygiene training this year. Five new staff have not yet attended fire training, but did receive induction training covering fire procedures in the home. Some staff have completed an infection control training course provided by an outside agency, and the manager said that there are plans for more staff to undertake this in the near future. Abuse training has been provided for most staff, however records showed that a small number of staff, included those recently recruited, have not yet received this training. Adult protection is covered in the induction programme, but any staff that has not yet attended a more comprehensive training course should do so as soon as possible. See recommendations 1 and 2. Cypress Court Nursing Home DS0000018723.V253532.R01.S.doc Version 5.0 Page 19 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 and 35. Quality assurance systems are in place to ensure that the home is run in the best interests of residents. Money held on behalf of residents is handled appropriately. EVIDENCE: The manager works as part of the team of nurses for at least one shift each week, usually more, and uses this opportunity to supervise and monitor staff. She also serves out meals three days a week and monitors the quality of the food. One of the nurses prepares the Duty rota and the night nurses complete a weekly pressure sore audit. The manager carries out a monthly accident audit. The home carries out its own annual review of residents and relatives are invited to attend. Cypress Court Nursing Home DS0000018723.V253532.R01.S.doc Version 5.0 Page 20 The home had a visit on 8th September from member of Cheshire County Council’s ‘Consultation and Participation Unit. A letter received sent to the home as a result of this visit stated: From the answers we received from your residents it seemed that the most important things to them were that there was a good laundry service; that a GP … attended the home; that they didn’t have to worry about their medication …; that the hairdresser and chiropodist visited; and they had a choice of food. Overall, they were more than happy with everything we asked them about. Residents and relatives meetings are held three monthly, and the minutes of the last meeting were available for reading. These showed that the main topic of conversation was activities, but relatives and residents were also able to raise any issues they wished to discuss. The manager is available one evening each week to speak with relatives. Southern Cross Healthcare has a satisfaction questionnaire that the home distributes to six residents, four staff, and four professional visitors each month. The manager and administrator said that very few of these questionnaires are returned. The area manager carries out monthly monitoring visits and produces a report to comply with regulation 26 of the Care Homes Regulations. A system of staff appraisal and supervision is in place. The home has a full-time administrator who is responsible for the day to day finances of the home. A regional administrator carries out an annual audit of the home’s administration. Approximately half of the residents have a small amount of personal money in the home’s safe and this is used for expenses such as hairdressing, newspapers and chiropody. The money is kept in individual envelopes and detailed records are maintained. A safe contents book records all items that are stored in the safe. Two residents do not have close relatives who assist with their financial affairs. One has appointeeship through the local authority. The other is a new resident, for whom a similar arrangement is being considered. The home maintains a building society account for donations and the manager, administrator and activities organiser decide how this will be spent. Cypress Court Nursing Home DS0000018723.V253532.R01.S.doc Version 5.0 Page 21 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 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 1 x x x x x x 3 STAFFING Standard No Score 27 x 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 x 3 x x x Cypress Court Nursing Home DS0000018723.V253532.R01.S.doc Version 5.0 Page 22 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 OP19 Regulation 23(2)(b) Requirement Repair or replace the flooring in the ground floor bathroom, laundry and kitchen. Timescale for action 01/01/06 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 2 Refer to Standard OP28 OP30 Good Practice Recommendations There should be further investment in training to maintain a skilled workforce. All staff should complete adult abuse training as part of their induction programme. Cypress Court Nursing Home DS0000018723.V253532.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 Cypress Court Nursing Home DS0000018723.V253532.R01.S.doc Version 5.0 Page 24 - 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!