CARE HOMES FOR OLDER PEOPLE
The Cambridge Nursing Centre 5 High Street Chesterton Cambridgeshire CB4 1NQ Lead Inspector
Lesley Richardson Key Unannounced Inspection 19th September 2007 10:20 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 The Cambridge Nursing Centre DS0000024271.V353434.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Cambridge Nursing Centre DS0000024271.V353434.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 Mrs Lynda Susan Sampford Care Home 90 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places The Cambridge Nursing Centre DS0000024271.V353434.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. One named person under 65 years with dementia The Commission has not restricted the age or number of people in either category. 20th March 2007 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 at 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 service users. All service user bedrooms are spacious and have en-suite facilities. All rooms are single. The home is arranged in units with each unit having a sitting room and dining room. The home has a dementia care unit for 40 service users. Fees at the home range between £530 and £860 per week. Copies of CSCI inspection reports are kept in the entrance of the home and are available for service users and visitors to the home should they wish to read them. The Cambridge Nursing Centre DS0000024271.V353434.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a key inspection of the service and it took place over 7 hours and 15 minutes as an unannounced visit to the premises. There were two regulation inspectors and an expert by experience present during the inspection. Time was spent talking to the 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. Information obtained through returned surveys from people in the home and visitors has also been used in this report. One requirement from the last inspection has not been met. There have been no more requirements, but one recommendation made as a result of this inspection. This is an adequate service. What the service does well:
Information about the home is provided before people move in and people said they also receive a contract. The home has recently started using a new assessment and care planning system. This means that there is much more information about people before they start living at the home. People have access to a range of health care professionals like dentists, opticians, dieticians as well as specialist nurses and their own doctor. The way staff members interact with people at the home has improved, particularly in one area where people who have dementia live. Staff are polite and respectful, and in this particular unit staff are more positive in how they approach people. This has resulted in a calmer and more pleasant atmosphere. There are a range of different activities available to people in the home; art and craft projects, physical activities from ‘sports for all’ and if people want to they can go out to church or other events outside the home. Visitors are also welcome at the home. One person said she had lots of visitors from her church “to celebrate my 90th birthday”. A new menu has been introduced recently, which gives people a much larger choice at meal times. There is also a snack menu available, so that people can eat at any time of the day or night. There are policies and procedures for making complaints or raising concerns about abuse. The home looks at complaints and does something about them. They also report any incident of possible abuse in the correct way, which means that people are listened to their concerns are acted upon if that is needed. The Cambridge Nursing Centre DS0000024271.V353434.R01.S.doc Version 5.2 Page 6 The home provides a pleasant place for most people to live; it is safe and well decorated. There is a programme of routine maintenance and there are plans for complete refurbishment by the end of this year. Quality assurance surveys are carried out every year at the home, where people are asked what they think of the care and the environment in which they live. An action plan is written to show how areas are to be improved. Money that is kept on behalf of people at the home is documented on a central computer. Interest is paid on this money and this is also recorded. Records are also kept of the health and safety checks that are carried out, which means the home can show if things are in good working order and what they have done to repair problems. What has improved since the last inspection? What they could do better:
Staff must be more careful about where they leave medication. A tub of prescribed cream was found in one person’s room, when it should have been locked away. This was in an area where there are a lot of people with dementia. As this was also found at the last inspection, it is really important that something is done to improve the storage of medication. The Cambridge Nursing Centre DS0000024271.V353434.R01.S.doc Version 5.2 Page 7 Although most people are able to make choices, comments from 2 people during the inspection made us think that not everyone has the same choice and that solutions are not always looked for hard enough. People should not have to go to bed when it is the best time for staff to use the hoist. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Cambridge Nursing Centre DS0000024271.V353434.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.V353434.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6 Quality in this outcome area is good. The home has adequate information about people before they live there, meaning they are able to make a decision about whether the person can be properly cared for before moving into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager or deputy manager carries out assessments before people move into the home. Further assessments are obtained from health and social care teams and provide additional information so the home is able to say whether it has the staff with the skills and experience to properly care for someone moving in. All of people who returned surveys said they have a contract with the home. Only half of these people said they received enough information before moving into the home, although one person said people at the home proof read the home’s brochure before it was printed. The Cambridge Nursing Centre DS0000024271.V353434.R01.S.doc Version 5.2 Page 10 The home does not provide accommodation specifically for intermediate care or for rehabilitation purposes. The Cambridge Nursing Centre DS0000024271.V353434.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. A change in the system used for planning care means care is beginning to be given in a more person centred way. Further improvements are needed for medication storage and the records kept making sure this is safe for people at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has recently started using a new assessment and care planning system. Although all the information relevant to each person’s care has always been available in one folder, the new system divides care into broad sections. Care plans and associated risk assessments are kept in respective sections, which provides an easy guide to staff and makes it clear why some care has to be given in a particular way. Each person in the home has an individual folder with this information. Care plans are written in enough detail for staff members to be able to care for people, but they do not give specific details about equipment that should be used. For example, information about people needing a hoist to transfer but
The Cambridge Nursing Centre DS0000024271.V353434.R01.S.doc Version 5.2 Page 12 not the size of the sling to be used, and that people should be turned regularly, but not how often. Nor are all care plans changed and updated when care needs change or the care practice changes, e.g. updating nutritional plans when this has been identified as a possible reason for developing a pressure sore, or the reason for poor healing. As this was not the plan relating directly to pressure prevention and treatment, this requirement has been partially met. However, there are details about people’s preferences and how staff should respond or anticipate behaviour that may be aggressive. One person’s plan includes details about the type of music he likes to listen to, that he enjoys visits from the family pet and what staff should do if he is not happy with the attention he is getting. 11 out of the 12 surveys that were returned by people living at the home said they usually get care and support when it is needed. People in the home have access to health care professionals and there was information in records seen to show referrals to dieticians, speech and language therapists, physiotherapists and other professional are made. Over 90 of people returning surveys said they usually have access to medical advice and support when they need it. Medication records for people on one unit in the home were looked at and show medication administration records (MAR) are generally completed correctly and tally with medication stored for people in the home. However, there were some entries where the MAR sheets had not been signed but the medication was no longer in the blister pack. A staff member, who has responsibility for medication administration, said the medication would have been administered if it had been removed. A prescribed cream was found in one person’s room in one of the dementia units, but this was not stored properly. As medication storage, particularly creams being left in people’s rooms, was found at the last inspection this requirement has not been met. We looked at how staff members interact with people living at the home while we were carrying out the inspection. Staff members are polite, respectful and caring in their approach to people, and in Fitzwilliam unit especially we saw positive interaction between staff and people living there. This has resulted in a calmer, less stressful environment. The Cambridge Nursing Centre DS0000024271.V353434.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. Activities and access to the local community provide positive experiences for people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an activities co-ordinator who arranges events and things for people to do in the home like art and craft projects, ‘sports for all’ and visits by entertainers and clergy. One person living at the home says she can go out to attend church and does this by alone, although in a wheelchair. Other people who said they did not want to go out said they are able to do what they want to keep their minds active, like reading the papers and going puzzles and crosswords. Two thirds of people who returned surveys said there are usually activities arranged that they could join in. A staff member in one of the units accommodating people with dementia engages people in a karaoke session most afternoons. Songs are older, but not predominantly from the war period, and everyone in the lounge was joining in. Even after the staff member was called away for a short period and people had started to do other things, many people were still singing. It was a very positive experience for many people and showed a much better picture of that particular unit than at the last inspection.
The Cambridge Nursing Centre DS0000024271.V353434.R01.S.doc Version 5.2 Page 14 Relatives and visitors to the home said they are able to visit when they want and a private area; either in someone’s own room, or another area in the home is available. People said they are able to have visitors, one person said she had lots of visitors from her church to celebrate her 90th birthday and another person said her son and his family visit twice a week. People said they are able to choose what to wear each day and what they want to eat, and as shown above for those people who are able they can choose to go out of the home to meetings. Those people who are more able can get up and go to bed when they want, but one person who needs help to get into bed said that bedtime is when staff members can manage with the hoist. Another person said that noise from other people’s televisions is a problem, especially when they are turned up loud and there are different programmes on. Noise from individual televisions was audible in corridors and there were a number of different programmes on at the same time. This has been discussed at residents meetings, but an appropriate solution has not been yet been found. Further attempts should be made to make the living environment pleasant for all people at the home and possibly looking at the sensory needs of people who have difficulty hearing. The home has recently introduced a new meal planning system that offers people more choice and identifies foods that could be included in different diets, like those that are high fibre. This accompanies the ‘nite bites’ snack menu that was seen at the last inspection and enables people to have a choice of hot or cold snacks at times other than main meal times. A new staff member has also been employed to help with meals and those people who need help to eat. The Cambridge Nursing Centre DS0000024271.V353434.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. People have enough information for them to be able to raise concerns and have them dealt with in the correct way. This judgement has been made using available evidence including a visit to this service. EVIDENCE: CSCI has received no complaints directly about the home since the last key inspection, but the home has received 17 complaints in the last 12 months. Nearly 60 of these complaints were found to have occurred. 83 of the people who returned surveys said they know how to make a complaint. Comments were positive in that people have not needed to make a complaint and the only negative comments were that more contact details for the BUPA organisation should be available. Nearly all staff members have received training in safeguarding adults from abuse, which should mean staff have a good understanding of abuse and when and how to report incidents. In the last year there has been one referral the local adult protection team, which resulted in an investigation and disciplinary procedures for the staff members involved. The home responded to this issue properly and took the correct action. The Cambridge Nursing Centre DS0000024271.V353434.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. Overall the standard of the environment provides a pleasant place for people to live, and the home puts measures in place to reduce unpleasant areas. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Accommodation in the home is on two floors, which are divided into four units; Fitzwilliam and Trinity on the first floor, and Churchill and Downing on the ground floor. All bedrooms are single rooms and people are able to bring furniture and other items in to make their rooms more personal. One person, who prefers not to watch the television, has a large number of books in her room, which she enjoys reading. The books can be accommodated because overhead ceiling tracks have been installed to help staff move this person in the hoist. The installation of the ceiling track was something the person and the home discussed and agreed on. The home is well maintained and decorated and there are attractive, secure gardens for people to use. One
The Cambridge Nursing Centre DS0000024271.V353434.R01.S.doc Version 5.2 Page 17 person said she likes to spend time out in the garden. Everyone living at the home that returned a survey said the home is always clean and fresh. However, there was still a smell of urine in some people’s rooms and when we first entered the home, although some of this reduced as the day went on. The manager said a new odour control system is being used and the home will undergo a complete refurbishment before the end of the year. This will put in new carpets that will be easier to clean and more resistant to stains and smells. The Cambridge Nursing Centre DS0000024271.V353434.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. Improvements in staff recruitment procedures and staffing numbers means that people at the home receive care when they need it, by staff who are safe to work at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager said that staffing numbers has improved slightly since the last inspection, giving staff support at mealtimes and more help on one unit during the day. Although 10 out the 12 people who returned surveys said there are usually staff members available when they are needed they also said they felt there should be more staff. There were a number of reasons that residents felt this way; because of the increasingly dependent people who come to live at the home, because they find it difficult to ask for simple things to be done when they know other people are waiting for care, and because they have to wait to go to the toilet. All staff receive mandatory health and safety training when they first start working at the home as part of their induction programme. Fire training records show staff training in this area is up to date. One staff member, who has only started working at the home in the last few months, gave examples of the range of health and safety training she had undertaken. She said she has also received training in adult protection and dementia care. The manager said there are plans for one person to complete train the trainer training in
The Cambridge Nursing Centre DS0000024271.V353434.R01.S.doc Version 5.2 Page 19 safeguarding adults, and for them to then give all staff members at the home regular training. 24 staff members have also received dementia care training over a period of 6 weeks, and the positive effect of this was seen during the inspection. Information provided before the inspection shows that approximately only 25 of non nursing qualified care staff have a NVQ at level 2 or higher. Staff files for 3 people employed since the last key inspection were looked at to see if required checks and information had been obtained before they started working at the home. The files showed this has been done and the home has complied with the requirement made at the last inspection. The Cambridge Nursing Centre DS0000024271.V353434.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. The home is managed to make sure people living there are safe and they are able to have a say in running the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is a nurse and is registered with the Nursing and Midwifery Council. She has worked in the home for approximately 10 years and has been registered with the Commission for Social Care Inspection as the manager since September 2006. She has completed the Registered Managers Award and is waiting for verification of this qualification. The home carried out a quality assurance earlier this year. A report was produced by the organisation’s head office, showing how the home has
The Cambridge Nursing Centre DS0000024271.V353434.R01.S.doc Version 5.2 Page 21 improved or not since the previous report. The home completes an action plan for areas that have been identified as needing improvement and the manager makes the changes that are needed. People going to live at the home are given written information about how their money is taken care of and the procedures involved in debiting an account. Statements are sent on a monthly basis, which shows the incoming and outgoing transactions, and any interest earned. Although individuals’ money is all placed into the same account, each person using the system has a separate written account and record on the computer. Information provided before the inspection shows that health and safety maintenance and servicing is carried out at the required intervals. The Cambridge Nursing Centre DS0000024271.V353434.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Cambridge Nursing Centre DS0000024271.V353434.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement Prescribed medication must be stored securely at all times. (This requirement has not been met.) Timescale for action 30/11/07 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 Refer to Standard OP27 Good Practice Recommendations The home should continue to monitor staffing numbers to make sure that people are able to choose how they are cared for. The Cambridge Nursing Centre DS0000024271.V353434.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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