Inspection on 27/08/08 for The Cambridge Nursing Centre

This inspection was carried out on 27th August 2008.

CSCI found this care home to be providing an Adequate 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 10/09/09

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 09/11/2008.

CARE HOMES FOR OLDER PEOPLE The Cambridge Nursing Centre 5 High Street Chesterton Cambridgeshire CB4 1NQ Lead Inspector Joanne Pawson Unannounced Inspection 27th August 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Cambridge Nursing Centre DS0000024271.V370785.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.V370785.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 bchthecambridge@bupa.com 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.V370785.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. 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 unit 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.V370785.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 1 star. This means the people who use this service experience adequate quality outcomes. We, the Commission for Social Care Inspection (CSCI) carried out a key unannounced inspection of Cambridge nursing Centre on 27th August 2008 from 10:00am until 17:00 pm and 2nd September 2008 from 9:30 until 13:00 pm using the Commission’s methodology described below. This report makes judgements about the service based on the evidence we have gathered. We spent time talking to the residents, manager and deputy manager and looking at care plans, health and safety documents, staff recruitment, supervision and training documents, and talking to the members of staff on shift. The manager also completed pre inspection information (Annual Quality Assurance Assessment) some of which will be included in this report. What the service does well: What has improved since the last inspection? The Cambridge Nursing Centre DS0000024271.V370785.R01.S.doc Version 5.2 Page 6 The home has been refurbished to a high standard and was clean throughout and there were no offensive smells. This gives the residents a nice environment to live in. A ‘hostess’ has been employed to work in the units in the mornings to help with tasks such as serving breakfast. What they could do better: The standard of care plans varied according to who had written them. Care plans must be updated as soon as necessary to ensure staff are aware of important information and the needs of the residents. The treatment of pressure sores must be completed as stated in the care plans and records kept of any treatment. This will help to ensure that residents receive the treatment they require and that they are not in pain. There must be accurate recording of the receipt and administration of medication. This will help to ensure that residents receive the medication they have been prescribed at the appropriate times. When a food intake chart is in use this must be completed accurately so that staff can ensure that the resident is eating enough food. All staff should be made aware of how to offer choices to residents. This will enable the residents to remain as independent as possible and have control over their lives. Staff must ensure that food is served to residents at the correct temperature. This will not only improve the taste but also the risk of food contamination. All staff must be aware of what forms abuse can take and the correct procedures for the reporting of any suspected abuse. The suspected abuse of any resident must be reported to the appropriate authorities so any necessary action can be taken to help protect the residents. Both of the doors leading to the laundry room were found to be unlocked. This could pose a risk to residents, as there are lots of cleaning chemicals stored in the laundry room. There must be sufficient numbers of staff on duty to ensure that residents do not have to wait unreasonable times to receive the support and care they need. The Cambridge Nursing Centre DS0000024271.V370785.R01.S.doc Version 5.2 Page 7 If staff are working before the receipt of a criminal records bureau check they must be supervised at all times. This will help to ensure the safety of the residents. There must be an up to date fire risk assessment so that risks can be identified and minimised where practicable. 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.V370785.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.V370785.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): 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 unless it is an emergency admission. 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. The Cambridge Nursing Centre DS0000024271.V370785.R01.S.doc Version 5.2 Page 10 As BUPA has introduced new assessment paperwork all of the residents living in the home have been reassessed to ensure all the necessary information is available. The home does not provide accommodation specifically for intermediate care or for rehabilitation purposes The Cambridge Nursing Centre DS0000024271.V370785.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): 7,8,9,10 Quality in this outcome area is adequate. Staff do not have all of the information they require to meet the needs of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans for four people were looked at as part of this inspection. They show that each person has a plan that gives staff members’ information about what they need to do to meet most of the identified needs. Each care plan contained a lifestyle profile. Although the paperwork used for the care plans were the same the quality and detail of the information varied according to who had written it. For example one care plan to help maintain skin integrity stated ‘regular turning’ the manager confirmed that this needed to be more descriptive so that staff knew what was expected of them. The Cambridge Nursing Centre DS0000024271.V370785.R01.S.doc Version 5.2 Page 12 One care plan stated ‘maintain close observation at all times when resident in bed’, the manager stated that the resident didn’t need a member of staff observing her all the time but would need regular checks. Another care plan was detailed and stated ‘staff to speak clearly and slowly allowing the resident to respond repeating instructions as often as necessary ensuring eye contact is maintained at all times’. Not all of the important information in assessments and reviews was used to update the care plan. One care plan stated that the resident’s husband visited regularly. However the resident’s husband had passed away in June 2008. If new staff were not aware of this important information it could cause the resident distress or confusion. Some of the care plans we looked at were written in a manner to encourage independence. One care plan contained information on what activities the resident enjoyed and how they could encourage him to become more involved. One residents care plan stated that she was at high risk of pressure sores. There was a continuous wound assessment chart that stated that the wound should be reassessed every three days and the dressing changed if necessary. There were lots of gaps in the chart of more than three days and on one occasion there was a gap of eleven days when there was no record of the wound being reassessed. Another resident told us that she had a pressure sore and that the dressing was supposed to be changed every three days. She stated that this did not always happen and that when it got to the fifth the pressure sore became painful. One residents care plan stated in her nutrional screening that she was at high risk of becoming malnourished. The dietician had visited in April 2008 and stated that the resident should have milky drinks and snacks to boost her calorie intake. The dietician had also advised that the resident should be on a soft diet. This information had not been transferred to her care plan. When we asked to look at the records of what the resident had eaten during August initially there were 15 days records missing. These records were found to be filed somewhere else. There were lots of gaps in the food intake records and there were no entries of snacks or milky drinks being offered. According to the residents weight chart she had lost weight for the previous three weeks however the care plan review stated ‘dietary needs reviewed’. The review did not state what the review found or if any different action should be taken. There was evidence of resident and relative involvement with the care plans. All of the care plans we looked at showed that the relevant healthcare professionals are involved when needed. The records for the administration of medication were looked at. For the first resident there didn’t seem to be any errors. For the second resident there was no signature to say a tablet had been administered but the tablet was missing from the blister pack. For the third resident one cream that was to be applied The Cambridge Nursing Centre DS0000024271.V370785.R01.S.doc Version 5.2 Page 13 daily was signed on some days but not others. The nurse in charge of the unit stated that creams are normally recorded as being applied in the daily notes and not in the medication administration sheets. For the fourth and fifth resident one of the medications was prescribed to take one daily when required. However there were no instructions on the medication administration sheet as to what ‘when required’ was and there were no information regarding this in the residents care plan. For the sixth resident 30 tablets had been delivered, there were only 28 signatures to say a tablet had been administered but there were no tablets left. For the seventh resident there were 28 tablets delivered, 18 signatures to say they had administered a tablet but there were 11 tablets left. For the eighth resident it was not possible to see if there were the correct amount of tablets left as there was no record of how many tablets had been carried forward from the previous months supply. Risk assessments, for things like falls and moving and handling, are completed and reviewed regularly. Residents were seen to be treated with respect for the majority of the time. The manager stated that from October 2008 there would be a new monthly audit of medication, which will have to be completed and sent to her line manager. One resident was observed in the dining room at kitchen time with a full glass of fortijuice in front of him. The resident had been asleep and woken up by a carer and taken to the lounge. We asked the nurse who was responsible for the administration of medication if the resident had received all of his fortijuice that morning. The nurse stated that he had and showed us where it had been signed as administered on the medication administration sheet. We showed the nurse the cup that was full of fortijuice and she stated that she would make sure he had another fresh glass. The rest of the strawberry fortijuice was poured into a glass which was then half full and then she opened a carton of lemon fortijuice and filled the glass. When asked if it was normal practice to mix the flavours she replied that it was as you could buy mixed fruit juice in the shops. The Cambridge Nursing Centre DS0000024271.V370785.R01.S.doc Version 5.2 Page 14 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): 12,13,14,15 Quality in this outcome area is adequate. Residents are given the opportunity to take part in a variety of activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff were observed offering the residents choices. One resident was observed calling for help. A member of staff came straight away and asked her if she would like a biscuit. When the resident replied no the member of staff asked her if she would like them putting in her wardrobe and if she would like help opening her post. Discussion with a new member of staff showed that he was aware of how he could offer choices to the residents such as what they would like to wear. One resident was observed being brought into the dining room for breakfast, he was not asked what he would like and a bowl of fruit and apple juice was placed in front of him without any verbal communication. A carer was then The Cambridge Nursing Centre DS0000024271.V370785.R01.S.doc Version 5.2 Page 15 observed dishing up a plate of scrambled egg, bacon and toast and leaving it on the side. Fifteen minutes later another carer served the plate to the resident. We asked if the food was still hot and the carer said it was. When we pointed out that the food had been dished up for fifteen minutes the carer stated he thought it was fine but that he would change it. We felt the food before it was taken away and it was cold. As hot trolleys have been ordered for the various units we will not make it a requirement to ensure food is served as the correct temperature as we expect the manager to deal with this issue. There was food all over the floor from breakfast in the dining room. At one point a carer slipped on some food but still did not clean it up. When the residents had finished their breakfast a carer helped them to walk to the lounge but they had to walk through the food on the floor. A number of residents had towels wrapped round them by the carers to prevent food spilling down them whilst eating. Another carer came into the dining room and found the stock of protectors that should have been used. One resident when asked about the food stated that all the soups tasted the same and that they were too thick. Whilst we were observing residents sitting in the lounge a resident asked a carer for a drink. The carer replied yes and left the room. Although the carer returned he did not bring a drink for the resident. The nurse sat down near the resident and placed a drink on the table for another resident to have with their medication. The gentleman that had asked for the drink picked it up straight away and drank it in one go. The same resident then asked the same carer for some food and was again told yes. The carer did not return with any food. One resident was sitting in front of the television in his wheelchair which was switched off as the music was on. A carer walked into the lounge and said ‘excuse me’ and turned the resident to face the other residents. The resident was not asked if he would like to be moved. For the half an hour we observed the residents in the lounge there was no interaction with the residents that sat quietly but lots of interaction with the residents that were more verbal. Residents were observed sitting in the lounge singing along to the music and later on some were seen enjoying a game with a balloon and hitting it back and forth to a carer. A variety of activities had been offered to the residents during August including music and movement, hand massages and manicures, games afternoon, church service, cake decorating, games in the garden, plant potting, film evening, walk in the garden, karaoke, reminiscence, arts and crafts and one to one with residents. The Cambridge Nursing Centre DS0000024271.V370785.R01.S.doc Version 5.2 Page 16 The deputy manager had accompanied a resident so that he could visit a local pub. The relative on a resident stated that she thought the home was good at providing activities. Some staff members have received training on the mental capacity act and how this could affect the residents. However one member of staff stated that if a resident refused to have shower she would ‘make something up such as tell her that her daughter is going to visit so that she had to have a shower’ even if she had the capacity to make the decision not to have a shower. We have not made a requirement about offering residents choices as we expect the home to manage this. The Cambridge Nursing Centre DS0000024271.V370785.R01.S.doc Version 5.2 Page 17 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): 16,18 Quality in this outcome area is adequate. Not all staff are aware of what constitutes abuse or the procedures to follow if they suspect abuse has taken place. This could place the residents at risk of being harmed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One resident stated that when she had complained to the manager it had been dealt with appropriately. The complaint log was inspected and all of the complaints had been investigated appropriately and any necessary action taken. The relative of a resident stated that if she had any concerns she felt confident that she could report them to the manager. Staff only complete training on the protection of vulnerable adults (POVA) by watching a video and answering questions. At present they do not complete the county council POVA training. Discussion with care staff showed that not all staff are aware of what constitutes abuse and what the correct procedures to follow are if any form of abuse is suspected. The Cambridge Nursing Centre DS0000024271.V370785.R01.S.doc Version 5.2 Page 18 When we looked at the incident reports for the last two months it was unclear if all cases of suspected abuse had been reported to the adult protection lead. The manager was unsure if all cases had been appropriately reported as it had been written as reported on some incident forms and not on others. The Cambridge Nursing Centre DS0000024271.V370785.R01.S.doc Version 5.2 Page 19 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): 19,20,21,23,24,25,26Quality in this outcome area is good. The home is a pleasant safe place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has had a complete refurbishment and was found to be clean and there were no unpleasant odours. The doors leading to the laundry room were found to be unlocked. The manager confirmed that staff are aware that they should be locked when they are no staff in the laundry room as the cleaning chemicals could pose a risk to the residents. The Cambridge Nursing Centre DS0000024271.V370785.R01.S.doc Version 5.2 Page 20 There are flatscreen freeview televisions in all of the nursing rooms and some of the residential rooms with an aim to provide them in all of the bedrooms. Cambridge City Council have recently inspected the kitchen areas and made seven requirements. The Cambridge Nursing Centre DS0000024271.V370785.R01.S.doc Version 5.2 Page 21 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): 27,28,29,30 Quality in this outcome area is adequate. Staff receive the mandatory training required but there does not seem to be training offered for the further development of the staff. This could mean that staff are not always aware of best practice and how they should be working with specialist needs such as residents with dementia. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three staff files were inspected. All of the files contained an application form and two written references. Staff are employed before the receipt of criminal records bureau (CRB)check. One member of staff without a CRB was seen working unsupervised on the day of the inspection. We have not made this a requirement as we expect the home to manage this issue. All staff complete a comprehensive induction including training on fire safety, food hygiene, infection control, moving and handling, health and safety and dementia. The deputy manager sits with new staff whilst they watch training videos so that they can ask any further questions. The Cambridge Nursing Centre DS0000024271.V370785.R01.S.doc Version 5.2 Page 22 The manager completed the pre inspection information and stated that out of 73 staff only 12 had an National Vocational Qualification at level 2 or above and only another 9 were working towards one. When asked what the staff were like one resident replied ‘staff are mixed, most are pretty good one or two are not interested in the job, they just stand there but don’t get involved’. One resident stated that ‘staff are normally polite’. One resident said that as she needed two members of staff to help her out of bed she had to wait until after 10.30 when staff had more time but if she needed to go out earlier she would tell the staff the day before and they would get her up earlier. The resident felt that there were not enough staff on shift and had to wait one hour and 20 minutes once for assistance but stated that this was exceptional and she didn’t normally have to wait that long. When asked about the staffing levels the manager stated that an extra staff member had been put on the morning shifts as a hostess to serve breakfast but that the home would benefit from higher staffing levels. A complaint had recently been received by the home from a resident’s husband who stated that staff are excellent but that there are not enough of them on shift which results in his wife having to wait long periods for help. For example his wife had had to wait 25 minutes and then 20 minutes when using the call bell. He stated for an incontinent and anxious patient this delay was intolerable. The pre inspection information that the manager completed stated that they intend to improve the service over the next 12 months by a further increase in staffing levels. One resident stated that if there were more staff on shift she would ask for help more often as she tried to limit her requests as she felt staff were to busy. When we spoke to a residents relative she stated that the communication between the staff was excellent and ‘staff are lovely, I took mum outside in the garden and the staff brought us a tray of tea’ she also stated that although the home was sometimes short staffed she didn’t think anything else could be improved. The Cambridge Nursing Centre DS0000024271.V370785.R01.S.doc Version 5.2 Page 23 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): 31,33,34,35,36,38 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 The Cambridge Nursing Centre DS0000024271.V370785.R01.S.doc Version 5.2 Page 24 manager since September 2006. She has completed the Registered Managers Award. 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 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. The home holds residents and relatives meetings. The last meeting was held in April 2008. The next meeting is scheduled for September 2008. The records for the fire safety checks were inspected and found to be satisfactory. The manager stated in the pre inspection paperwork that all equipment is maintained and serviced as required. The Fire service inspected the home in February 2008 and made a requirement that there must be an up to date fire risk assessment however this was still not available in the home. The manager stated that a risk assessor had been to the home to complete the assessment but that she had not received a copy of it. Records and discussions with the care staff show that they are receiving regular supervision and support from a line manager. 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. The Cambridge Nursing Centre DS0000024271.V370785.R01.S.doc Version 5.2 Page 25 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 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X 3 3 3 3 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 3 3 3 2 The Cambridge Nursing Centre DS0000024271.V370785.R01.S.doc Version 5.2 Page 26 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(2)(b)& (c) Requirement Timescale for action 01/11/08 2. OP8 17(1)(a)S chedule 3(3)(n) 3. OP8 17(1)(a) Schedule 3(3)(l) 4. OP9 13(2)17(1 )(a) Care plans must be kept under review and updated and changes occur so that staff have all the information they require to meet the needs of the residents. Pressure sores must be given the 01/10/08 treatment they require as stated in the care plan. Records relating to the treatment of pressure sores must be kept. This will ensure that residents with pressure sores receive the healthcare they need. Where a resident has a need for 01/10/08 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. Complete and accurate records 01/10/08 must be kept of all medication received, administered, or not, together with a reason why the medicine was not given, in order to demonstrate that residents receive the medicines prescribed for them. This was a DS0000024271.V370785.R01.S.doc Version 5.2 The Cambridge Nursing Centre Page 27 requirement from the previous inspection. Failure to meet this requirement may lead to the commission taking enforcement action. 5. OP9 12(1)13(2 )15 Were medication is prescribed on 01/10/08 a when required basis, there must be clear guidelines in care plans as to the circumstances for their use. This will protect residents from harm. This was a requirement from the previous inspection. Failure to meet this requirement may lead to the commission taking enforcement action. The manager must ensure that all allegations or suspicions of abuse are reported to the relevant authorities. A record must be kept of this so the manager can ensure it has been done. This will help to ensure the safety of the residents. Cleaning chemicals must be stored securely. This will help to ensure the safety of the residents. There must be sufficient staffing levels at all times to meet the need assessed needs of the residents. All staff must receive training so that they are 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. There must be an up to date fire risk assessment. This will help to identify and minimise the risk of fire where practicable. DS0000024271.V370785.R01.S.doc 6. OP18 13(6) 01/10/08 7. OP26 13(4)(c) 01/10/08 8. OP27 18(1)(a) 01/11/08 9. OP30 18(1)(i) 01/11/08 10. OP38 23(4)(a) 01/11/08 The Cambridge Nursing Centre Version 5.2 Page 28 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.V370785.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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