Inspection on 10/09/09 for The Cambridge Nursing Centre

This inspection was carried out on 10th September 2009.

CQC found this care home to be providing an Poor service.

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

The Cambridge Nursing Centre 27/08/08

The Cambridge Nursing Centre 19/09/07

The Cambridge Nursing Centre 30/11/05

The Cambridge Nursing Centre 05/05/05

The Cambridge Nursing Centre 22/09/04

The Cambridge Nursing Centre 10/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE The Cambridge Nursing Centre 5 High Street Chesterton Cambridgeshire CB4 1NQ Lead Inspector Joanne Pawson Unannounced Inspection 10th September 2009 10:00 DS0000024271.V377450.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The Cambridge Nursing Centre DS0000024271.V377450.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Cambridge Nursing Centre DS0000024271.V377450.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Cambridge Nursing Centre Address 5 High Street Chesterton Cambridgeshire CB4 1NQ 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) 01223 323774 robert.york@ansplc.co.uk www.bupa.co.uk BUPA Care Homes (ANS) Ltd Manager post vacant Care Home 90 Category(ies) of Dementia (90), Old age, not falling within any registration, with number other category (90) of places The Cambridge Nursing Centre DS0000024271.V377450.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Older people, not falling within any other category - Code OP Dementia - Code DE Physical Disability - Code PD (maximum number - 1) The maximum number of service users who can be accommodated is: 90 27th August 2008 2. Date of last inspection Brief Description of the Service: Cambridge Nursing Care Centre is a purpose built nursing home on two floors with the upper floor accessed by passenger lifts. It is situated just off the junction of Elizabeth Way and Chesterton High Street not far from the centre of Cambridge. The home is spacious, light and airy and has attractive gardens that are accessible to the residents. All bedrooms are spacious and have ensuite facilities. All rooms are single. The home is arranged in units with each unit having a sitting room and dining room. The home has two dementia care units totalling 40 residents. Fees at the home range between £890 and £895 per week. Copies of CSCI inspection reports are kept in the entrance of the home and are available for residents and visitors to the home should they wish to read them. The Cambridge Nursing Centre DS0000024271.V377450.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was a key inspection of this service and it took place over 12 hours on the 10th and 14th of September 2009 as an unannounced visit to the premises. It was spent talking to the acting manager and staff working in the home, talking to people who live there and observing the interaction between them and the staff, and examining records and documents. One requirement from the last inspection has been met and two requirements (to complete food charts accurately and to ensure there is sufficient staff at all times) have not been met. There have been thirteen further requirements and no recommendations made as a result of this inspection. Information obtained from the Annual Quality Assurance Assessment and from returned surveys was also used in this report. 27 surveys were returned from people who live at the home, and 11 were returned from the staff. A high number of the surveys from the people living at the home contained negative comments about issues around being treated with dignity. There is a new manager at the home although she has not applied to be registered with the commission, for the purpose of this report she will be referred to as the acting manager. A manager from another BUPA home who had recently worked in the home whist there had been no manager was also present for the inspection. What the service does well: There has been an improvement since the last key inspection in August 2008 of the administration and recording of medication. This ensures that the residents get the right medication at the right time and that there are clear records of what has been administered. One resident survey told us that the home provides comfort, courtesy and consideration. What has improved since the last inspection? At the last inspection some medication was left unattended this could place the residents at risk. All of the medication was securely stored on the day of the inspection. The Cambridge Nursing Centre DS0000024271.V377450.R01.S.doc Version 5.2 Page 6 The acting manager has implemented a new cleaning schedule in response to a complaint about a resident’s bedroom not being cleaned. There are now clear instructions for the domestic staff about what should be cleaned everyday. The manager is aware that the food has not been of an acceptable standard and has worked with the kitchen staff to produce a new menu and provided better equipment in the kitchen so that food can be prepared to a better standard for residents who require a soft diet. There is also a food comments book in each unit for the staff to record any comments about the food so that they can be followed up by the cook. Although work has been undertaken to improve What they could do better: The care plans are not always updated with the information staff require to meet the needs of the residents. Staff do not always follow the information in the care plans for example one care plan stated that the residents blood sugar levels should be monitored twice daily and that this should be recorded on the relevant chart however there was no record of it being completed twice a day at all and no record of it being completed even once a day for several days over the last three months. This could place the residents’ health at risk. Residents’ dignity is not always upheld for example one resident was seen having her blood taken in the lounge whilst other residents were present. The surveys received from residents told us that residents do not always wear there own clothes and that clothes often go missing. Although there is an activities organiser there is a lack of activities that are suitable for people living in the home who have dementia. This means that those residents with dementia are not given a chance to take part in suitable activities that they can enjoy. Not all of the residents know how to make a complaint. This may stop residents from complaining if they are not happy with anything in the home. We spoke to three of the nurses on shift and none of them could tell us what they should do if they suspected a resident had been abused. This could place the residents at risk from being abused or harmed. Calls bells are not always accessible to the residents. Staff must make sure that call bells are accessible and in working order so that residents can request help if they need it. There must be adequate hot water at all times in the residents bedrooms. The recruitment procedure must be followed so that the right people are employed and the residents are not placed at risk. When we asked to look at the training records we were told that there are not clear and accurate records for all staff and the person responsible for keeping the records up to date had left and there didn’t seem to be a clear record of what training staff had completed in the past. The acting manager was aware of the problem and where there was no evidence that staff had attended training they would be booked onto the appropriate training. Those staff responsible for supervising other staff should have training to ensure that the supervision sessions are effective and staff receive the support they need. The Cambridge Nursing Centre DS0000024271.V377450.R01.S.doc Version 5.2 Page 7 The finance officer was on leave on the day of the inspection. Although there was access to the safe the staff were not aware of where the record of valuables was kept. In the absence of the finance officer other staff must be aware of the valuables record so that if residents ask for any valuables to be returned they are available. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. The Cambridge Nursing Centre DS0000024271.V377450.R01.S.doc Version 5.2 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 The Cambridge Nursing Centre DS0000024271.V377450.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 People using the service experience good quality outcomes in this area. Residents are confident that the home can meet their needs before they move into the home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The care plans we looked at contained pre admission information that had been completed so that the home knew that they could meet the residents’ needs before they moved in. The Cambridge Nursing Centre DS0000024271.V377450.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People using the service experience poor quality outcomes in this area. Care plans do not contain all of the up to date information that staff require so that they can meet the residents needs. Residents’ dignity is not always promoted. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Staff are required to complete food and fluid charts when there is an identified need that a resident maybe at risk from poor nutrition or dehydration. At the last key inspection a requirement was made that the food and fluid charts must be completed accurately so that staff could monitor the food and drink intake of those residents at risk and take any action necessary i.e. refer to The Cambridge Nursing Centre DS0000024271.V377450.R01.S.doc Version 5.2 Page 11 dietician or offer high calorie snacks. When we looked at the food charts for three residents we found that there were numerous occasions when no food or fluid had been recorded. We looked at the care plan for one resident whose food/fluid chart had not been completed accurately to see if they needed to have a record of what they consumed. The care plan stated that the resident has a longstanding history of anorexia and will usually find a reason not to eat. It also stated that that the resident had fortsip supplements twice a day. We looked at the administration of medication records to see if the resident was receiving her fortisips however there was no record of fortisips for this resident. When we asked the staff about this they told us that the resident was no longer on fortisips but the care plan had not been updated. The care plan review contained notes from the dietician that the resident should have high calorie drinks and snacks in between meals. However there are no high calorie drinks or snacks recorded on the residents food/fluid chart. The residents must (weight and BMI risk assessment) assessment states that she must be weighed weekly but this was not being done. The resident had been weighed in September (according to a list on the wall in the nurses station) however this information was not transferred to her care plan. The resident had lost weight for the previous two months. Although the dietician had visited the resident and given her advice this advice was just recorded in the care plan evaluation but the care plan had not been updated with the advice. We asked if there were records held anywhere else that was a record of what the resident consumed and were told that there was not. We also looked at the food and fluid charts for another two residents and they also had not been completed fully. We looked at the care plan for one resident and it contained detailed information about their mental health issues and guidance for staff about how they should react to certain behaviours. There was also good information about what medication the resident was prescribed and why it had been prescribed and the possible side effects for the staff to look out for. The care plan stated that the resident was to have their blood sugar monitored twice a day which should be recorded on the blood monitoring form however the form only had one record on it for each day and in July four days had no record, in August 6 days had no record and up to the inspection (14 September) there were no records for two days in September. We looked at the care plan for a third resident. The resident was frequently taking her clothes off in public areas of the home. Although the care plan had been updated to say that she was doing this it did not give the staff enough information about what they should do when this happened. The residents care plan about her dementia was written in a positive way and stated ‘staff should demonstrate a calm and friendly approach, take time to explain the options and repeat if necessary’. We looked at the medication administration records and controlled drugs record and stock and found them all to be satisfactory. The complaints log showed that a resident had been without his medication for five days in May. The Cambridge Nursing Centre DS0000024271.V377450.R01.S.doc Version 5.2 Page 12 All of the nurses responsible for the administration of medication on the day of the inspection stated that they had never received training in the home for medication although they had received it as part of there nurse training. Staff had not had their competency assessed for the administration of medication since working in the home. The acting manager was already aware of this issue and had devised an administration of medication competency test for all the nurses which she would be completing with them. There is a poster which states who the homes first aiders are. However some of the staff have left the home and none of them worked nights. Their must be a first aider available at all times to ensure the safety of the residents and staff. We observed a member of staff taking a residents blood in the lounge when other residents were present. When asked the member of staff told us that she did not think it was dignified for the resident but that the lighting was better in the lounge so it was better for her eyesight. Any personal or healthcare should be carried out in the residents own bedroom or in a private area. One of the resident’s surveys told us that the resident’s clothes are always going missing even though they are named. Another survey stated that the resident did not always have his own clothes on. It also stated that his books and vases disappear and other people photographs are left in his room. Another survey told us that the home could improve by doing the little things such as wiping the resident’s mouth after meals, seeing that the resident’s teeth are in place and clean and helping the resident not to spill their drinks. Another survey stated ‘they need to take care of peoples clothes as they often lose them and they have lost two sets of my relatives false teeth’. All of these issues undermine the residents’ dignity. 27 surveys were returned to the Commission which had been completed by the residents (some with the support of others). 18 of the residents told us that they always receive the support care they need, 66 told us that they usually did, 7 told us that they sometimes did, 3 told us that they never did and 3 didn’t know. 55 of the residents’ surveys told us that they always received the medical care they needed and 37 said that they usually did. The Cambridge Nursing Centre DS0000024271.V377450.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People using the service experience poor quality outcomes in this area. There are not enough suitable activities for residents living in the home who have dementia. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There is an activities organiser in the home and there are some activities organised. On the day of the inspection a few residents were seen taking part in a discussion about current affairs and looking through a newspaper and discussing the articles. However there is a lack of activities for people who have dementia. The activities organised for the week we visited included discussion about current affairs and a musical quiz, jewellery making, cake decorating and a games afternoon, making Celtic photo frames and hand massages and manicures. No activities were advertised for Tuesday, Wednesday or Sunday. The Cambridge Nursing Centre DS0000024271.V377450.R01.S.doc Version 5.2 Page 14 One resident told us that she had only been out of the home three times since the previous Christmas and that was when a relative could take her out. She told us that she would like to get out more often. We observed lunchtime on one unit. All of the residents were helped into the dining room at 11.45am. Lunch was served at 12 for some residents however because the majority of the residents needed staff to assist them with their meal the (and there were not enough staff for all the residents) the last resident did not receive their meal until 1.45pm. Although the lunchtime could have been staggered all the staff were in the dining area so no staff would be in the other areas of the unit. One member of staff was observed assisting a resident to eat in a gentle and encouraging way and explained each time what was on the fork. One resident was given a glass of sherry with there meal and said ‘just the job’. The same resident kept asking what day it was. (There was no information anywhere in the home for the residents to tell them what day or date it was). There were many negative comments about the food. We looked through the food comments book in one unit and noted that there had been 5 complaints since the 27th August. The staff also told us that there was not always a suitable option for people who needed a soft diet i.e. only cakes in the afternoon or dessert at lunch time was prunes with the stones still in them. They also told us that sometimes the food did not look very appetising and a recent meal had consisted of white steamed fish with white rice and the alternative was faggots with rice but no vegetables. The surveys returned to the commission from the residents told us that 7 of them always liked the meals, 37 usually did, 37 sometimes liked the meals and 14 never liked the meals. One relative of a resident stated that the staff had been a great help in helping them to come to terms with the sudden illness there relative had suffered. The Cambridge Nursing Centre DS0000024271.V377450.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People using the service experience poor quality outcomes in this area. Staff are not aware of the correct procedure to follow if they suspect a resident has been abused. This is placing the residents at risk of harm or abuse. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The nurses are in charge of each unit and when the manager is not on duty are the most senior people in the home. When we spoke to one nurse she stated that she had worked at the home for several years but that she had never received training on safeguarding vulnerable adults. However she was aware that there was a policy and checklist and she told us she would find these and read it if she suspected someone had been abused. We spoke to another nurse in charge of another unit and asked her what she would do if a resident told her she had been hit by a member of staff. The nurse told us that she would speak to the member of staff that the resident had made the accusation about and then tell the resident that she was sorry that it had happened and that she would work with her in future. This does not follow the correct procedure if abuse is suspected and could put the residents The Cambridge Nursing Centre DS0000024271.V377450.R01.S.doc Version 5.2 Page 16 at risk. The nurse told us that although she had worked at the home for several years she had never received any training in safeguarding vulnerable adults. We spoke to a third nurse on another unit and she also did not know what the correct procedure was to follow if she suspected a resident had been abused. One of the surveys we received raised some safeguarding issues around the behaviour of staff. Although we have passed this information onto the safeguarding team we do not have the details of the resident the survey is about. If staff are not aware of the correct procedure to follow when they suspect abuse has occurred it could go unreported and allowed to happen again. The home must make arrangements to prevent the residents being harmed or suffering abuse or being placed at risk of potential harm or abuse. The complaints procedure was on the wall in the reception. When we looked at the complaints log we found that the home had not reported a serious incident to the commission. The incident was dealt with appropriately. The surveys returned to the commission from the relatives showed us that 59 were aware of how to make a formal complaint but 29 did not know how to make a formal complaint. The Cambridge Nursing Centre DS0000024271.V377450.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,24,25,26 People using the service experience adequate quality outcomes in this area. The physical environment does not always meet the specialist needs of the people who use the service. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: When we spoke with one resident in her bedroom we noticed that she had a large ceramic lamp which was broken on one side and had dangerous sharp edges on it. The resident told us that she had woken up one morning to find it like that with the broken pieces next to it in a bowl. The drawers were also The Cambridge Nursing Centre DS0000024271.V377450.R01.S.doc Version 5.2 Page 18 broken and when we asked her how long they had been like that she told us that they had always been broken. She also told us that she paid extra for a room with doors that led out to the garden but that the key was missing. When she had asked for a key to get outside and plant some pots near her window she was told there was no key but that the door could be unlocked. The door was left unlocked for three days but the resident said that she had felt unsafe at night with the door unlocked so had asked for it to be locked again. This had happened several weeks before the inspection but there was still no key available in the bedroom to unlock the door. When we asked the resident if she needed assistance from a member of staff what she would do she told us that she would use the call bell. However the bed was up against the wall and the call bell was down in between the bed and the wall. When we pulled the call bell out we tried it to see if it worked. The call bell was not pushed into the socket properly and did not work. One of the surveys we received from a relative stated that they did not have a suitable buzzer. In one of the lounges we observed a gentleman trying to get out of his recliner chair with a leg either side of the reclined foot support. The resident could not get out of his chair and was calling for help. Because there was no staff nearby to hear no one came to help. When we went to use a call bell to get the assistance of a member of staff we saw that all three call bell points on the wall had a chair in front of them and none of them had a lead plugged in to them to be used by a resident. We had to lean over a high backed chair to be able to use the call bell. This could stop a resident trying to use a call bell or could cause an accident if they were trying to reach the call bell. The staff told us that there has been an ongoing problem with no hot water in some of the bedrooms. When we were looking around the home we heard a visitor to the home ask a member of staff for a bowl of hot water so that her relative who lived in the home could have a wash as there was no hot water in his bedroom. The majority of the home was found to be clean and without offensive odours. Some of the chairs in the dining room on Churchill were dirty and needed cleaning. One of the surveys from a resident stated ‘the home sometimes does not appear to smell very fresh’. Another survey stated ‘the room could be cleaned better and fresh air sprayed as the room often smells badly of urine’. The Cambridge Nursing Centre DS0000024271.V377450.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People using the service experience adequate quality outcomes in this area. The staffing levels do not allow for individualised person centred support. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We looked at the staff files for three members of staff. For one member of staff the recruitment procedures had not been followed and information received as part of the recruitment procedure had not been recorded as investigated. There was no record of the staff members induction held in the home. The acting manager told us that the member of staff would have an induction booklet which would state what induction training she had completed. The second file was for a member of staff that started working at the home in August and again there was no record of the training he had received. The file did contain all of the necessary recruitment information. The third file contained the recruitment information and a record of training. The Cambridge Nursing Centre DS0000024271.V377450.R01.S.doc Version 5.2 Page 20 The person responsible for the recording of all training had recently left the home and it was difficult to see which staff had received what training. The staffing levels were an issue raised by the majority of the staff we spoke to and some of the residents. One member of staff told us that there are 16 residents on one unit – one resident requires one to one care so for the other 15 residents there is 3 carers and one nurse. Although this appears to be a high ratio, 14 of the residents need two members of staff to assist with personal care. The staff felt that this meant that their job is task orientated. For example when helping with personal care and eating staff felt that there is no time to spend just talking to the residents or engaging in an activity with them. The staff surveys told us that for the 11 staff that returned the surveys none of them thought that there was always enough staff to meet the individual needs of the residents, 29 thought that there usually were enough staff, 36 thought that there were only enough staff sometimes and 18 thought that there were never enough staff. The surveys returned to the commission from the residents told us that 22 of them thought that there was always staff available when they needed them, 44 said that they were usually available, 25 said that staff were sometimes available, 3 said that there were never staff available and 3 said that they didn’t know. The staff surveys returned to the commission showed that 18 of those that replied thought that the manager regularly gave them enough support, 27 thought that she often did, 36 thought that she sometimes did and 18 felt that she never did. The Cambridge Nursing Centre DS0000024271.V377450.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 People using the service experience adequate quality outcomes in this area. The new manager has highlighted areas that need improvement and is trying to deal with the most important first. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There is a new manager who had been working in the home for four weeks at the time of the inspection. The Cambridge Nursing Centre DS0000024271.V377450.R01.S.doc Version 5.2 Page 22 Two of the nurses responsible for supervising staff told us that they had never had any supervision training so were not sure if they were doing it right. We looked at the record for the servicing of the hoists and slings and this was satisfactory. The fire alarms are being tested weekly. We noticed that on the handover forms in one unit two residents had recently had a fall. We asked to see accident forms for these two accidents. Only one form could be found. We looked at the most recent quality assurance report carried out by BUPA. In 2007 84 of the residents stated that they thought the overall quality of care in the home was excellent or very good but in 2008 that had reduced significantly to 45 . In 2008 65 of the residents thought that the number of staff in the home was totally unacceptable. The Cambridge Nursing Centre DS0000024271.V377450.R01.S.doc Version 5.2 Page 23 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 1 8 2 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X 1 X 2 2 2 STAFFING Standard No Score 27 2 28 X 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 3 X 2 2 3 3 The Cambridge Nursing Centre DS0000024271.V377450.R01.S.doc Version 5.2 Page 24 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. Standard OP7 Regulation 15 Requirement Timescale for action 01/12/09 2. OP8 12(1)(a) Care plans must be up to date and provide clear guidance; drawn up in consultation with the resident or their representative. This is to ensure that staff have up to date guidance in how to meet the current needs of the residents. 01/11/09 Where a resident has a need for a food chart these must be completed accurately. This will allow for the staff to assess if the resident is receiving enough food or if other measures need to be taken to ensure they do not become malnourished. This requirement had a timescale of 06/04/09, which has not been met. A further timescale has been agreed. Staff must make proper provision for the health and welfare of the residents. This includes where needed the monitoring and recording of blood sugar levels. This will help to ensure the residents health. Staff must promote the residents DS0000024271.V377450.R01.S.doc 3. OP8 12 01/11/09 4. OP10 12(4)(a) 01/11/09 Page 25 The Cambridge Nursing Centre Version 5.2 5. OP12 16(2)(M) &(N) 6. OP15 16(2)(I) 7. OP16 22 8. OP18 13(6) 9. OP22 23(2)(n) 10. OP24 23(2)(c) 11. OP25 23(2)(j) 12. OP27 18(1)(a) 13. OP29 19 dignity at all times. This will ensure that the resident dignity is maintained. Activities must be planned according to the interests and capabilities (including those residents with dementia) of the residents living in the home. This will ensure that all those that want to take part in activities. Residents must receive a wholesome, appealing and balanced diet. So that residents enjoy the food they are eating. All residents and/or their representatives should be aware of how to make a complaint. This will ensure that where needed complaints can be made and dealt with. All staff must be aware of the types of abuse and what they should do if they suspect a resident has been abused. This will help to ensure the safety of the residents. Call bells must be accessible and working at all times. This will ensure that residents can request the help of staff when they need to. The furniture in residents’ bedrooms must be in a good state of repair. This will provide a better environment for the residents. Hot water must be available in the residents’ bedrooms. This will give them adequate washing facilities. There must be sufficient staffing levels at all times to meet the assessed needs of the residents. This requirement had a timescale of 06/04/09, which has not been met. Recruitment procedures must be followed to help ensure the DS0000024271.V377450.R01.S.doc 01/12/09 01/11/09 01/11/09 01/11/09 01/11/09 01/11/09 01/12/09 01/11/09 01/11/09 Page 26 The Cambridge Nursing Centre Version 5.2 14. OP27 18 (1)(c)(i) 17(2)sche dule(4)(9) 15. OP35 safety of the residents. Staff must receive the training they require to ensure they have the skills necessary to meet the needs of the residents. There must be an accessible record of the valuables kept on behalf of the residents. This will allow the residents access to their valuables. 01/12/09 01/11/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Cambridge Nursing Centre DS0000024271.V377450.R01.S.doc Version 5.2 Page 27 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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