Inspection on 26/09/06 for Cypress Court Nursing Home

This inspection was carried out on 26th September 2006.

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 11/10/05

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 A Gillian Matthewson Unannounced Inspection 26th September 2006 09:45 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.V307218.R03.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. Cypress Court Nursing Home DS0000018723.V307218.R03.S.doc Version 5.2 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 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.V307218.R03.S.doc Version 5.2 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. 11th October 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 has good access to local amenities and services, including public transport. The home provides personal and nursing care and accommodation for up to 60 people over 65 years of age. 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. There is also a small garden with patio area to the rear of the property. Cypress Court Nursing Home DS0000018723.V307218.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced, started at 09.45am and was carried out over a period of ten hours. The registered provider was also invited to provide evidence as part of this process. The inspector spoke to the operations manager, the home manager, five staff members, ten residents and two relatives, their views being taken into account. As part of the inspection process, four residents’ records were examined in respect of the care they receive. Staff records and other documentation were examined. A tour of the premises was also undertaken. Comment cards were received from 17 relatives and five health and social care professionals. These were, in the main, very positive. Comments included “There has been considerable improvement in my mother’s health since she came to Cypress Court. All the staff have contributed to this.” “ Top-rate staff who deal with residents in a caring, common sense way.” Four relatives had concerns about staffing numbers and two about hygiene. What the service does well: The manager is resident focused and works to improve services and provide an increased quality of life for residents. There is a strong ethos of being open and transparent in all areas of running the home. Cypress Court provides a pleasant, warm, bright and well-maintained environment, which is clean and comfortable. The home is well equipped to meet the needs of residents. Residents are assessed prior to admission to ensure the home can meet their needs. Care plans give clear instructions to staff on how to meet those needs. Cypress Court Nursing Home DS0000018723.V307218.R03.S.doc Version 5.2 Page 6 Visitors are made welcome and are involved in the planning of care. A good variety of food is provided. Staffing levels are sufficient to meet residents’ needs and residents are very happy with the care provided by the staff. They feel they are treated with respect. Residents feel confident that they can raise any concerns and they will be addressed. They are protected from abuse. What has improved since the last inspection? 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. Cypress Court Nursing Home DS0000018723.V307218.R03.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 Cypress Court Nursing Home DS0000018723.V307218.R03.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this area is good. This judgment has been made using available evidence including a visit to the service. Residents needs are assessed before moving into the home to ensure that their needs can be met. EVIDENCE: Care documents relating to four residents were examined. Pre-admission assessment documentation had been completed for these people by the manager and senior staff from the home. Residents confirmed that the manager or a senior nurse from Cypress Court had been to see them and discussed their requirements before offering a place in the home and agreeing care plans to meet their assessed needs. One resident said “The manager was very particular to ask what my needs were and the staff bend over backwards to meet them.” Cypress Court Nursing Home DS0000018723.V307218.R03.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this area is good. This judgment has been made using available evidence including a visit to the service. The care that residents receive is based on their individual needs. The principles of respect, privacy and dignity are put into practice. EVIDENCE: All the residents who were case tracked had a plan of care in place to inform staff of the actions they needed to take to meet the residents’ assessed needs and minimise risk. Evidence from care plans indicated that the health care needs of residents were being met, with reference to professional advice and treatment sought. Care plans also contained evidence that residents and their relatives were consulted at regular intervals. One of the senior nurses is responsible for the ordering of medication. She said that 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. The facilities for medicine storage were satisfactory, as were the administration records. A contract for the disposal of unused medicines was in place, which included containers for the destruction of controlled drugs. The home had a risk assessment form for Cypress Court Nursing Home DS0000018723.V307218.R03.S.doc Version 5.2 Page 10 residents who may wish to self-administer, but no-one was self-administering their medication at the time of the inspection. The senior nurse said that residents were given the choice, subject to risk assessment. Eight of the residents spoken with them confirmed that staff treat them with respect. Staff were observed to have a good rapport with the residents and a pleasant and cheerful manner. The home had policies and procedures in place in relation to the practices of various religions and was planning training in diversity for the staff. Cypress Court Nursing Home DS0000018723.V307218.R03.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this area is good. This judgment has been made using available evidence including a visit to the service. 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: Residents confirmed they could make choices in their daily routines and were not restricted in their choice of lifestyle. One resident said one member of the night staff tries to encourage her to go to bed at about 8.30pm but she had refused because she likes to stay up late. This information was passed to the manager to address. The home employs an activity organiser and there was a weekly programme of activities in every room. A hairdresser visits the home on a regular basis. An ecumenical minister also visits and will provide holy communion to those who require it. Although the range of activities seemed limited, the residents spoken with said they were satisfied with what was on offer. A couple of the residents said they wished staff had more time to chat. Residents and visitors confirmed that relatives and friends are encouraged to visit the home and it was noted that residents could receive their visitors in private. Cypress Court Nursing Home DS0000018723.V307218.R03.S.doc Version 5.2 Page 12 The registered provider contracts with an advocacy service called Care Aware to provide an independent advocate for anyone who may require this service, for example a resident with no relatives. The home provides a 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. A member of staff was observed going round to ask residents what they wanted from the following day’s menu. Some residents said they didn’t want what was on the menu and requested something else. The staff member said this was not a problem and residents confirmed that they always got what they requested. One lady said she liked Italian food and the chef would cook it for her. All residents had a nutritional risk assessment and were weighed at least monthly. A ‘Nutritional Intake Record’ form was used when there was concern, and care plans contained evidence that a dietician was consulted when necessary. Staff were observed serving the evening meal. They confirmed that each resident was still happy with their previous choice of meal before serving. Tables were set nicely with a flower arrangement as a centrepiece and food was well presented. Two residents said the food was not always hot enough. The manager said this had been a problem and he had purchased two hot trolleys to address this. Cypress Court Nursing Home DS0000018723.V307218.R03.S.doc Version 5.2 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. Quality in this area is good. This judgment has been made using available evidence including a visit to the service. Residents have access to a robust, effective complaints procedure and are protected from abuse. EVIDENCE: The home had a satisfactory complaints procedure that was displayed in the home and contained in the service user guide. All residents spoken with said they would raise any concerns they may have with the manager and felt confident he would address them straight away. Pre-inspection information submitted by the manager indicated that there had been eight complaints in the last year, three of which had been partially substantiated, but were now resolved. The home had satisfactory policies and procedures in place for dealing with any suspicion of abuse and staff received training in this on induction and periodic updates throughout their employment. Staff spoken with were familiar with the procedures. Cypress Court Nursing Home DS0000018723.V307218.R03.S.doc Version 5.2 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): 19-26. Quality in this area is adequate. This judgment has been made using available evidence including a visit to the service. The physical design and layout of the home enables residents to live in a safe and comfortable environment. EVIDENCE: On the whole, the home was clean and well maintained. Accommodation met the minimum space requirements and there were with adequate kitchen, laundry, bathing and sluicing facilities. Residents were able to personalise their rooms with small pieces of furniture and personal items. One bedroom did have an odour of urine. The bath seat in the bathroom opposite room 11 was damaged. (The manager said a new one had been ordered.) The base plate of a turning aid in one resident’s room was dirty. It was also noted that there were a lot of overgrown weeds in the rear courtyard. Cypress Court Nursing Home DS0000018723.V307218.R03.S.doc Version 5.2 Page 15 The manager said that there was new lounge furniture on order. One visitor said that his only complaint was in relation to the laundry, clothes going missing and his relative being dressed in other’s clothes. This was discussed with the manager, who said that he had purchased net bags and boxes for every resident, so that their clothes would all be washed and dried in their own bag, then ironed and placed in a box with their name on. He hoped this would resolve the problem. Cypress Court Nursing Home DS0000018723.V307218.R03.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this area is adequate. This judgment has been made using available evidence including a visit to the service. Staff are in sufficient numbers to fulfil the aims of the home and meet the needs of the residents. EVIDENCE: The home employs 10 registered nurses and 29 care assistants. Rotas submitted prior to the inspection indicated staffing shortages at the end of July / beginning of August due to high levels of sickness. The manager explained that this had been due to some staff being on long-term sick leave and a tummy bug affecting both staff and residents. The manager had taken measures to address the sickness levels in the home and 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. Seven of the home’s care staff have an NVQ Level 2 or equivalent qualification in care. This equates to 24 . The Department of Health’s target is for 50 of care staff to achieve a qualification in care by 2005. The home has not achieved this target, but the manager said that eleven more staff are now studying for the award. Staff files relating to the last four staff recruited were inspected. Each file contained a completed application form, interview notes, a health declaration, a POVA first check, and evidence of a Criminal Records Bureau disclosure application. Two of the staff only had one reference, which was not from their Cypress Court Nursing Home DS0000018723.V307218.R03.S.doc Version 5.2 Page 17 last employer. The manager said that he had obtained these, but was unable to find them. One of the staff did not have a current photograph on file. The home has an induction training programme that complies with the Skills for Care induction standards, but one staff file contained no evidence that the staff member had received the training. One member of staff interviewed said that her induction had covered two days and another’s induction record had been completed over two days. The induction programme is intended to be covered in the first three months, which calls into question whether the induction training provided is in sufficient depth. The manager had identified this as a concern and was intending to review the induction procedures with the senior staff. The administrator maintains a training matrix, which records the dates on which each member of staff last received training. However, this was not up to date, so it was difficult to ascertain whether staff training was up to date without looking in each individual training file. The manager had asked the administrator to tidy the staff files. The home did have a regular programme of training events. In the last three months there had been training sessions in fire safety, food hygiene, continence management, wound care, venapuncture, manual handling, protection of vulnerable adults and nutrition. Cypress Court Nursing Home DS0000018723.V307218.R03.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38. Quality in this area is good. This judgment has been made using available evidence including a visit to the service. The management of the home is based on openness and respect. Quality assurance systems are in place to ensure that the home is run in the best interests of residents. EVIDENCE: The manager in post was appointed in February. He had not submitted an application for registration to the Commission at the time of the inspection. He is a first level registered general nurse with many years experience in the Army and a Member of the Institute of Leadership and Management. All of the residents and staff spoken with were very positive about his management style and felt they could go to him with any concerns. One staff member said “he’s strict but you can go to him at anytime and you know he’ll listen and act fairly.” A resident said “he’s very jovial and I enjoy our little chats. If I have any problems he sorts them out straightaway.” A social worker commented on Cypress Court Nursing Home DS0000018723.V307218.R03.S.doc Version 5.2 Page 19 “good hands-on management.” A relative commented “the manager is very dynamic, very approachable and willing to listen to problems and accept responsibility.” Southern Cross Healthcare has a satisfaction questionnaire that the home distributes to 10 of residents and relatives each month. The manager and administrator said that very few of these questionnaires are returned. The last responses were received in April, and were generally positive. The home manager carries out a home audit every month, which is reviewed by the operations manager. At the last audit done in August the home scored 94 . The operations manager also carries out monthly monitoring visits and produces a report to comply with regulation 26 of the Care Homes Regulations. Regular staff meetings are held and a residents’ and relatives’ meeting was held in April, after which the manager produced an action plan to address the issues raised. Most people spoken with on the inspection said that things were much improved, for example meals. 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. The home maintains a building society account for donations and the manager, administrator and activities organiser decide how this will be spent. The home has developed a health and safety policy that meets health and safety requirements and legislation. Staff receive training in safe working practices and adequate equipment is provided. Cypress Court Nursing Home DS0000018723.V307218.R03.S.doc Version 5.2 Page 20 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 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 X 3 Cypress Court Nursing Home DS0000018723.V307218.R03.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? NO 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 OP26 Regulation 16(2) (j&k) 19 Schedule 2 18(1) Requirement Timescale for action 29/10/06 2 OP29 3 OP30 4 OP31 8 The registered person must ensure that all equipment is kept clean and all rooms are free from offensive odours. The registered person must 29/10/06 ensure that two references are obtained for every employee and that a current photograph is held on file. The registered person must 29/10/06 ensure that staff complete the full induction programme in their first three months of employment. The registered person must 30/11/06 ensure that the manager submits an application for registration with the Commission. Cypress Court Nursing Home DS0000018723.V307218.R03.S.doc Version 5.2 Page 22 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 OP19 OP29 OP30 Good Practice Recommendations The rear courtyard garden should be weeded. The staff files should be reorganised to make it easier to locate the information in them. The staff training matrix should be updated and maintained. Cypress Court Nursing Home DS0000018723.V307218.R03.S.doc Version 5.2 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. 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