Inspection on 27/04/05 for Cypress Court Nursing Home

This inspection was carried out on 27th April 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 11/10/05

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 Broad Street Crewe Cheshire CW1 3DH Lead Inspector Anthony Cliffe Unannounced 27 April 2005 09:00 am th 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 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 F51-F01 S18723 Cypress Court V222247 270405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cypress Court Address Broad Street Crese Cheshire CW1 3DH 01270 588227 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Southern Cross Healthcare (Cheshire) Ltd Mrs K Hilditch Care Home 60 Category(ies) of OP (Old Age) registration, with number of places Cypress Court F51-F01 S18723 Cypress Court V222247 270405 Stage 4.doc Version 1.30 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). 2. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidance issued through the Commission for Social Care Inspection. 3. The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 15th October 2004 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 fiftysix 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 service users.The home is registered to accommodate older people assessed as requiring nursing care or personal care. Registered nurses are on duty at all times of the day and night. The nurses are supported by a team of care assistants who provide personal care for service users. Ancillary staff are employed to provide domestic services including laundry, cleaning, maintenance and catering. Cypress Court F51-F01 S18723 Cypress Court V222247 270405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit took place over a period of seven hours by two inspectors as part of the Commission for Social Care Inspection’s statutory inspection programme. The inspection was carried out using a process of cross referencing the documentation of identified service users following discussion with them, and following the delivery of care and support to them. A tour of the building and a number of bedrooms was completed, including the laundry facilities. Two requirements from administration were met. the previous inspection regarding medication Eight service users and four relatives contributed their experience of living in and visiting the home. Eight of the staff on duty were spoken with. What the service does well: Cypress Court Care Home provides a pleasant, warm, bright and wellmaintained environment, which was clean, odour free and comfortable. There is a choice of lounges with furniture and furnishings in good condition. Externally there are patio garden areas. The home is on two storeys and is well equipped to meet the needs of service users. Care plans had been well written and provided good information about each service user’s needs and what care they required. They were up to date and recorded any changes to the needs and the care required. Service users’ health needs were met and all of the people we spoke with were satisfied with the care that they received. Visitors were made welcome. A good variety of food was provided, including cooked breakfast every day. There is a stable staff group who had a positive attitude towards service users, with no agency staff used. The home had a competent and experienced manager. Service users we interviewed stated they were well cared for and staff were friendly and generally responded quickly to calls for assistance. Cypress Court F51-F01 S18723 Cypress Court V222247 270405 Stage 4.doc Version 1.30 Page 6 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 F51-F01 S18723 Cypress Court V222247 270405 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Cypress Court F51-F01 S18723 Cypress Court V222247 270405 Stage 4.doc Version 1.30 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 standard(s) 1 and 3 The home’s Statement of Purpose and Service Users’ Guide informs service users about the management arrangements in the home. There was evidence to show that all service users had been fully assessed before moving into the home to ensure that their needs could be met. EVIDENCE: The home’s Statement of Purpose and Service Users’ Guide had been amended to reflect the change in the registered manager. Care documents relating to five service users were examined. These showed that the people most recently admitted to the home had been admitted under arrangements with the local authority and Primary Care Trust. Pre-admission assessment documentation had been completed for these people by staff from the home. For the two most recent admissions, assessments were available from the social worker and from professionals at Leighton hospital. A service user admitted in an emergency had the necessary records completed on the day of admission. Cypress Court F51-F01 S18723 Cypress Court V222247 270405 Stage 4.doc Version 1.30 Page 9 The home had agreed care plans with service users needs. Two service users spoken with said staff had care needs. One of the service users said she did not and another said she was aware of her records, with detailed social and family history. to meet their assessed asked them about their know about a care plan her family completing a Cypress Court F51-F01 S18723 Cypress Court V222247 270405 Stage 4.doc Version 1.30 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 standard(s) 7,8, 9 and 10 Each service user had a plan of care providing details of their needs. These care plans were kept up to date to ensure that health and social care needs were identified and planned for. Service users’ heath needs were met in full. The home had improved their procedures for managing medication, but additional improvements are needed in record keeping and communication to ensure service users receive their prescribed medication. Other than meal times, there were no set routines within the home so service user choose their daily routine. EVIDENCE: A number of care plans were examined. All plans had a comprehensive range of assessment documents completed in full with a care plan to support the identified needs of the service users. One plan contained a detailed family and social history completed by the individual’s family. Cypress Court F51-F01 S18723 Cypress Court V222247 270405 Stage 4.doc Version 1.30 Page 11 Care plans had been reviewed each month and a statement was made to reflect whether there had been any changes to any of the identified needs and the action required to meet the need. Daily entries in the care plans showed that staff were aware of each service user’s needs. Evidence from care plans indicated that the health care needs of service users were being met, with referrals for professional advice on tissue viability recorded. The tissue viability nurse was visiting the home to advise staff on the wound management of a service user she said’ the staff are managing tissue viability issues very well, and use the service for help and advice. Staff have received training and this has improved care standards on wound management’. The care plans of two service users showed that they were receiving support from a dietician. A member of care staff spoken with was aware of the needs of these people and was able to describe the action being taken to address their nutritional needs. Evidence from care plans and from conversations with service users and their relatives, indicated that the health care needs of service users were met, and people spoken with expressed their satisfaction with the care being provided at the home. One service user said ‘staff are under orders only to help me when I cannot do something’, ‘they only help then, and I make sure they help me keep my independence’. The service user said she would like to manage her own medication and the manager said staff would assess her capability to do so. The service user had expressed a wish to speak to her social worker about her future and the manager had promptly arranged this. Another service user was observed to wait for 20 minutes for her call for assistance to be answered and said ‘ staff could have come and explained to me that they would attend to me and that would have been OK’. The manager explained that this situation had occurred due to the absence of two members of care staff that morning. Additional staff had been asked to come in to cover the shortfall and they had done this, but there had been a period of a couple of hours without sufficient staff. We also discussed the relative ‘isolation’ of this particular area of the building and the manager considered that it was more suited to more independent residents. Service users commented they could choose how they spent their day and staff respected their wishes to have privacy alone if they wished. A service user said she had tried eating in the dining room with the other service users and one lady who was very noisy had spoilt it. She had chosen to eat in her bedroom but said she may try the dining room again and staff had asked her to consider this. There were details of activities available and arranged in the home. The activities coordinator had recently commenced employment and was keen to develop the range of activities in the home. Cypress Court F51-F01 S18723 Cypress Court V222247 270405 Stage 4.doc Version 1.30 Page 12 Medicine administration had been completed appropriately on the ground and first floor units. On the first floor there were codes recorded on the medicines administration sheet, which looked like signatures of administration. On the ground floor a service user had been supplied with medicines when admitted from hospital and the home had obtained medicines in monitored dosage packs. There was some confusion about the medicines administered as both supplies had been used. Initially those supplied from hospital had been used for four days then sent for disposal. A blister pack was then used. Medicines were left in the blister pack, and it took time to ensure the amounts in stock tallied with records of administration of medicines to the individual concerned. The senior carer explained that it was a lack of communication that meant two supplies of medicines were used. See recommendations 1 and 2. Cypress Court F51-F01 S18723 Cypress Court V222247 270405 Stage 4.doc Version 1.30 Page 13 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 standard(s) 12 and 13 Service users can make decisions about their lifestyle preferences. Families and friends are welcomed into the home at any reasonable time. EVIDENCE: Service users said they could exercise choices about how they spent their day and maintained contact with their families. One lady talked about celebrating her birthday in the home and outside of the home with her family. Other service users present said this was an enjoyable social occasion. Service users enquired about the arrangements for voting at the general election, and voting cards were noted in individual’s bedrooms. A service user who had recently moved into the home said she had agreed with staff how she liked to be cared for and wished to spend time in her bedroom. Another service user said she could join in the activities available and staff encouraged her to do so, but also respected her choice not to. Cypress Court F51-F01 S18723 Cypress Court V222247 270405 Stage 4.doc Version 1.30 Page 14 There were a number of visitors to the home throughout the day. They were made welcome and were clearly comfortable in approaching the staff and discussing any issues with them. Visitors commented they could visit any time. One bedroom had been tastefully furnished and equipped to a high standard with additional soft furnishings, pictures and toiletries in it. This was identified as a demonstration bedroom to show prospective service users. The manager and operations manager agreed to place a notice in any bedroom prepared for this purpose, explaining this was not a standard bedroom. The notice would explain the bedroom was an example of how a bedroom could be personalised, so not to mislead prospective service users. Cypress Court F51-F01 S18723 Cypress Court V222247 270405 Stage 4.doc Version 1.30 Page 15 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 standard(s) 16 and 18 Service users are aware of the complaints procedure, and are protected from abuse. EVIDENCE: The home has an Adult Protection procedure (including Whistle Blowing), which complies with the Public Disclosure Act 1998 and the Department of Health Guidance No Secrets. Staff had received training regarding Adult Protection. The inspectors spoke with service users they had spoke with at previous inspection visits and who had expressed dissatisfaction with the home. The service user said they were very happy with the care and ‘we’re well cared for’. One service user recently admitted to the home said she was very happy and had remained at the home despite alternative arrangements made for admission to another care home. She said she had put on weight and staff were ‘helpful’. Another service user recently admitted to the home said staff were ‘polite’ and ‘courteous’ and if she wished to complain she would speak to her social worker. Both service users said staff used their preferred names. Cypress Court F51-F01 S18723 Cypress Court V222247 270405 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21 and 26 Service users live in a safe and well-maintained environment. The home is clean, pleasant and hygienic. EVIDENCE: All communal areas of the home and a sample of bedrooms were visited. These were found to be well maintained, clean and odour free. A programme of planned re-decoration had been drawn up in 2004 and was almost complete. The manager said that she would be agreeing a new programme for 2005. The maintenance person was decorating an unoccupied bedroom, and he confirmed his awareness of the maintenance programme. He said that he was very busy at this time due to additional work needed to keep the gardens in good order. Only one area was noticed to be in need of repair and this was the flooring in one of the bathrooms. Cypress Court F51-F01 S18723 Cypress Court V222247 270405 Stage 4.doc Version 1.30 Page 17 The laundry was clean and well organised. The staff member working in the laundry was aware of infection control precautions. The care staff following laundering puts Service users’ personal clothing away. The laundry assistant keeps all un-named items separate and gives them to the care staff for identification. See recommendation 3. Cypress Court F51-F01 S18723 Cypress Court V222247 270405 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 28 The provides sufficient numbers of staff to meet service users needs, but further investment in training is needed to maintain a skilled workforce. EVIDENCE: A review of the staff rota showed that registered nurses and care assistants were employed in sufficient numbers to meet the needs of service users. The homes own bank of staff covers any shortfalls. Additional professional support was available to service users from staff at the PCT and local authority. Evidence was available that referrals were made when necessary. The manger discussed the needs of a service user and informed the inspector that a referral for reassessment would be made. Another service user had been reassessed as requiring personal care and not nursing care due to improvements in health. Only three of the home’s care staff had completed an NVQ qualification, however there was evidence that all staff received regular training. The manager said that three other staff were working towards NVQ level 3, and a new training agency had been contracted to provide support for more staff to have the opportunity to achieve NVQ qualification. See recommendation 4. Cypress Court F51-F01 S18723 Cypress Court V222247 270405 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 38 The home is run and managed by a person who is fit to be in charge. Safe working practices are maintained to protect service users health and safety. EVIDENCE: The home has a very experienced and competent manager who is a registered nurse and has completed the process for registration as manager with the Commission for Social Care Inspection. The manager had not yet completed the registered manager’s award. Service users interviewed were able to complete comment cards and give verbal comments on the home. Service users could identify who the manager was and confirm they knew whom they could make a complaint to if they wished. One service user said ‘the manager is very nice and always comes and has a word with you’. Cypress Court F51-F01 S18723 Cypress Court V222247 270405 Stage 4.doc Version 1.30 Page 20 The manager had responded to a number of requirements made by the environmental health officer regarding hygiene and food handling practices, during a visit in February 2005. She had completed an action plan, which identified that all the requirements had been addressed. A new head chef had been appointed since the environmental health officer’s visit. On the day of the inspection the kitchen appeared clean and tidy and staff had received food hygiene training. The chef said that he intended to do the advanced food hygiene certificate later in 2005. We discussed monitoring arrangements for the kitchen with the home manager. She said that the company’s arrangements for this were changing. Previously, Southern Cross’s facilities manager inspected kitchens every three months, but new cleaning schedules were being introduced into the kitchen and the home manager would have responsibility for auditing the kitchen and the cleaning schedules on a monthly basis. Maintenance records for all plant and equipment were inspected and were found to be up to date. Fire records were inspected and showed that a new risk assessment had been carried out, equipment was tested and maintained, and staff received training. Twenty members of staff had recently completed infection control training and contracts were in place for the disposal of waste. Water chlorination had been carried out in September 2004. Records inspected showed that staff received regular training regarding health and safety topics. Cypress Court F51-F01 S18723 Cypress Court V222247 270405 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x x x x 3 Cypress Court F51-F01 S18723 Cypress Court V222247 270405 Stage 4.doc Version 1.30 Page 22 no 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 Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP9 OP9 OP21 OP28 Good Practice Recommendations Staff should ensure that signatures confirming the administration of medicines are written legibly. Staff should ensure that communication regarding the stock of medicines being used for an individual is clear and only one stock of medicine is used at a time. The bathroom floor identified should be replaced. There should be further investment in training to maintain a skilled workforce. Cypress Court F51-F01 S18723 Cypress Court V222247 270405 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit D, Off Rudheath Way Gadbrook Park Northwich Cheshire, 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 F51-F01 S18723 Cypress Court V222247 270405 Stage 4.doc Version 1.30 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. 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