Care Home: Cambridge Nursing and Residential Care Home (The)

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What the care home does well Good care was evidenced when observing staff interacting with residents and carrying out their duties. All staff were observed to treat residents with kindness and respect. Effective team working was observed throughout the inspection. The routines of daily living are flexible to suit the differing needs and preferences of all people living in the home. There is a relaxed atmosphere throughout the home. Residents appeared unhurried and are given sufficient time and support in their every day lives. All files showed evidence of the home having undertaken a comprehensive preadmission assessment, with the involvement of the resident where possible, and their relatives. Initial assessments identified people`s religious needs and how this might affect the way in which they wish to be cared for. The home supports residents to express their religious and cultural identity to maintain their well-being. We observe that staff were able to respond to residents and meet their needs. Admissions to the home only take place when staff have the skills to meet the individuals needs. Care plans were personalised, and referred to the cultural needs of people. People are involved in the planning of their care that affects their lifestyle and quality of life. Residents` dietary needs are recorded as part of their care plans (for example if they were diabetic or needed a puree meal). Residents are able to enjoy the food they prefer and like. The procedures for the recruitment of staff are robust and provide safeguards for people living in the home. Staff spoken to understood how to work to minimise the possibility of cross infection. Effective infection control measures are in place to ensure the safety of people living at the home.The home has a system for obtaining the views of the quality of the service it provides. Residents and relatives are encouraged to participate in determining the future development of the service. The home has a consistent record of meeting the relevant health and safety requirements and closely monitors its own practice. Health and safety checks, procedures and training make sure that residents are safe. What has improved since the last inspection? All the requirements made at the last key inspection have been met. Generally the care plans were detailed and gave a real sense of the individual resident and their care needs. There is a general programme of activities available. This is now more varied and flexible to suit not only individual`s preferences, but also more appropriate to the capacities of people living with dementia. We were told that carers are now more involved in activities with the residents, and we observed this during the inspection. Since the last inspection a number of improvements have been made to the general environment. This includes new showers fitted to the top and ground floor bathrooms; flat screen televisions and DVD players for lounges; and improvements to the patio area. Replacement or the provision of specialist equipment such as reclining chairs and hoists; new gates to the rear of the premises for improved security and more appropriate external enclosures for household and clinical waste. What the care home could do better: Whilst care plans were being regularly reviewed, the manager should ensure that reviews are undertaken in a meaningful way and do not become a routine exercise with "no change" being automatically recorded each month.Staff need to ensure that daily recordings are more in line with outcomes identified in the care plans and also that the implications of the Mental Capacity Act 2005 are routinely taken into account in both care planning and daily recordings. Care plans should reflect the changing needs of people and the ways in which their well-being is maintained. Some care plans were very detailed, gave a real sense of the individual resident and were very personalised. However, other care plans contained only standardised statements and did not reflect the detail of care being provided. Care plans should provide a detailed picture of how the needs of people are being met, particularly where the person`s needs are complex, or where they may not be able to communicate their needs and preferences to their carers. It is strongly recommended that where a resident has an allergy to either medication or food; it is recorded more prominently and highlighted on the front sheet of the residents file and on the Medication Administration Record (MAR) chart. Allergies should be identified to make sure that residents are safe. CARE HOMES FOR OLDER PEOPLE Cambridge Nursing and Residential Care Home (The) 61 Cambridge Park Wanstead London E11 2PR Lead Inspector Tony Brennan & Gwen Lording Unannounced Inspection 11:50 5th September 2008 to 16 September 2008 th 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 Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.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. Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cambridge Nursing and Residential Care Home (The) 61 Cambridge Park Wanstead London E11 2PR Address 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) 020 8989 1175 cambridgenursinghome@btconnect.com Cambridge Nursing Home Ltd Mr Abdool Rashid Mahmadkhan Ebrahimkhan Care Home 49 Category(ies) of Dementia (9), Dementia - over 65 years of age registration, with number (9), Old age, not falling within any other of places category (32), Physical disability (8) Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th September 2006 Brief Description of the Service: The Cambridge Nursing and Residential Care Home is a privately owned care home with nursing for 49 people. It is registered to provide nursing and personal care and accommodation for both younger adults (18 to 65) and older people (65 plus). It is situated in Wanstead close to local shops and other amenities, and is well served by public transport. The home is a large, detached, property, set back from the main road with parking to the front, and an enclosed garden to the rear. The accommodation is spread over three floors, which are accessed by both stairs and a lift. The ground floor houses the kitchen and laundry, together with 17 bedrooms, a lounge, dining room, and conservatory. The first floor has 23 bedrooms, a lounge and a dining room, and the second floor has nine bedrooms and a lounge. There are toilets and bathrooms, with assisted baths, on each floor. Thirty-five of the bedrooms are single, with 28 having an ensuite toilet. There are also seven double bedrooms, each with an ensuite toilet. One of the joint proprietors, Mr Ebrahimkhan is also the registered manager. On the day of the inspection the fees for the home were between £583:00 and £1200:00 per week. A copy of the Statement of Purpose and Service User Guide is made available to both the resident and the family. A copy of the most recent inspection report is available on request. Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.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 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced inspection and took place over three days. The main inspection was undertaken by two inspectors namely the lead inspector Gwen Lording and Tony Brennan. A short, focused, unannounced visit took place on 5th September. Overall, a selection of records and documents were examined by four of the Commission’s staff. The home’s registered persons were available throughout all days of the inspection and co-operated fully with the inspection activity. This was a key inspection in the inspection programme for 2008/ 2009. Information was taken from an Annual Quality Assurance Assessment (AQAA); which was completed by the manager and returned to us prior to the inspection. This is a self-assessment process, which all providers are required to complete. Additional information was also obtained from Regulation 26 monitoring reports and Regulation 37, notifications. Discussions took place with the registered providers, kitchen, domestic and administrative staff. We spoke to a number of residents and relatives on each floor; and where possible residents were asked to give their views on the service and their experience of living in the home. Nursing and care staff were asked about the care that residents receive, and were also observed carrying out their duties. Observations of the interaction between staff and service users was made, using the principles of the Short Observation Tool for Inspection (SOFI), a methodology specifically designed for use in homes where people have dementia or learning disabilities. Information about the quality of care provided was also obtained from discussion with local and health authority commissioning and review staff. A tour of the premises, including laundry and the main kitchen was undertaken. The files of several residents on each floor were case tracked, together with the examination of other staff and home records. This included medication administration, staff training and staff recruitment procedures and files and maintenance records. Prior to the inspection, serious allegations were made about the quality of care that some residents receive. The allegations were subject to investigation under the London Borough of Redbridge Safeguarding Adults procedures. No evidence was found to substantiate any of the allegations. The registered providers were fully co-operative throughout all stages of the safeguarding adults procedure. Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.R01.S.doc Version 5.2 Page 6 We would also like to thank the residents, relatives and staff for their input during the inspection. What the service does well: Good care was evidenced when observing staff interacting with residents and carrying out their duties. All staff were observed to treat residents with kindness and respect. Effective team working was observed throughout the inspection. The routines of daily living are flexible to suit the differing needs and preferences of all people living in the home. There is a relaxed atmosphere throughout the home. Residents appeared unhurried and are given sufficient time and support in their every day lives. All files showed evidence of the home having undertaken a comprehensive preadmission assessment, with the involvement of the resident where possible, and their relatives. Initial assessments identified peoples religious needs and how this might affect the way in which they wish to be cared for. The home supports residents to express their religious and cultural identity to maintain their well-being. We observe that staff were able to respond to residents and meet their needs. Admissions to the home only take place when staff have the skills to meet the individuals needs. Care plans were personalised, and referred to the cultural needs of people. People are involved in the planning of their care that affects their lifestyle and quality of life. Residents’ dietary needs are recorded as part of their care plans (for example if they were diabetic or needed a puree meal). Residents are able to enjoy the food they prefer and like. The procedures for the recruitment of staff are robust and provide safeguards for people living in the home. Staff spoken to understood how to work to minimise the possibility of cross infection. Effective infection control measures are in place to ensure the safety of people living at the home. Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.R01.S.doc Version 5.2 Page 7 The home has a system for obtaining the views of the quality of the service it provides. Residents and relatives are encouraged to participate in determining the future development of the service. The home has a consistent record of meeting the relevant health and safety requirements and closely monitors its own practice. Health and safety checks, procedures and training make sure that residents are safe. What has improved since the last inspection? What they could do better: Whilst care plans were being regularly reviewed, the manager should ensure that reviews are undertaken in a meaningful way and do not become a routine exercise with “no change” being automatically recorded each month. Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.R01.S.doc Version 5.2 Page 8 Staff need to ensure that daily recordings are more in line with outcomes identified in the care plans and also that the implications of the Mental Capacity Act 2005 are routinely taken into account in both care planning and daily recordings. Care plans should reflect the changing needs of people and the ways in which their well-being is maintained. Some care plans were very detailed, gave a real sense of the individual resident and were very personalised. However, other care plans contained only standardised statements and did not reflect the detail of care being provided. Care plans should provide a detailed picture of how the needs of people are being met, particularly where the person’s needs are complex, or where they may not be able to communicate their needs and preferences to their carers. It is strongly recommended that where a resident has an allergy to either medication or food; it is recorded more prominently and highlighted on the front sheet of the residents file and on the Medication Administration Record (MAR) chart. Allergies should be identified to make sure that residents are safe. 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. Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.R01.S.doc Version 5.2 Page 9 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 Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.R01.S.doc Version 5.2 Page 10 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 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s needs are assessed prior to admission to the home to make sure they receive the care and support they need. National Minimum Standard number six is not applicable to this service, as the home does not provide intermediate care. EVIDENCE: Individual records are kept for each resident and a number of files were examined for residents accommodated on each floor, including the files of residents who had recently been admitted to the home. All files showed Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.R01.S.doc Version 5.2 Page 11 evidence of the home having undertaken a comprehensive pre-admission assessment, with the involvement of the resident where possible, and their relatives. Where appropriate, information provided by the placing authority was also included. One of the resident’s case tracked was identified in their initial assessment as having a risk of falls, and a need for wound care. These needs had been addressed in the person’s care plan and the necessary risk assessments had been carried out. We observed that staff were able to respond sensitively to this resident. The initial assessment included information on the dementia care needs of residents. This included any behavioural issues that the individual might have. Admissions are not made to the home until a full needs assessment has been undertaken to ensure the best outcomes for people. Initial assessments identified peoples religious needs and how this might affect the way in which they wish to be cared for. A resident case tracked was identified as being of the Hindu faith. Staff spoken to understood how this might influence how she wished to be cared for. They understood that the resident preferred to be cared for by female members of staff when being assisted with personal care. The home supports residents to express their religious and cultural identity to maintain their well-being. Pre-assessment visits to the home by family/ friends and, where possible, the prospective resident are encouraged. This gives people an opportunity to talk to staff, residents and visiting relatives and assess the home’s facilities. The relative of one resident recently admitted to the home told us: “I visited a few homes and chose this one because people were friendly and there was a nice atmosphere. My mother’s placement has been made permanent and I am very happy. She has settled very quickly, everybody is so nice and I have peace of mind”. The home understands the importance of having sufficient information when choosing a care home. We observe that staff were able to respond to residents and meet their needs. For example, supporting them when eating and drinking. Staff spoken to on the dementia unit understood, and were able to explain the needs of individual residents. They understood how dementia could affect an individual’s behaviour. They were able to explain how they responded to the residents who were case tracked. A resident commented, “ Staff are very, very good.” Admissions to the home only take place when staff has the necessary skills to meet the assessed needs of prospective residents. Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.R01.S.doc Version 5.2 Page 12 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 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are consulted about how they want their personal, social and medical care needs to be met. People who use the service are fully protected by safe procedures for handling medication. People’s right to privacy is supported. EVIDENCE: Individual care plans were available for each resident and a total of eight residents were case tracked, both on the ground and first floor, and their care plans and related documentation inspected. In addition, a further 12 files were examined in relation to specific allegations of poor practice. Generally care plans were comprehensive and covered areas such as night care and sleep, communication, continence care, mobility, moving and handling and nutrition. Where a resident had a specific need such as catheter care, wound care or Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.R01.S.doc Version 5.2 Page 13 management of diabetes, then the necessary care plan was in place. One of the residents case tracked had a detailed care plan identifying the nutritional needs. This identified that they had a puree diet. We observe staff supporting this person to eat and this was done in line with the care plan. There were clearly defined actions highlighted in the care plans to meet the needs of individuals. Care plans were personalised, and referred to the cultural needs of people. A resident who is Hindu was recorded as preferring to have a shower. Diary notes showed that the resident was assisted to have a shower regularly. People said that staff respected their privacy and treated them with respect. Good care was evidenced when observing staff talking to residents and carrying out their duties. All staff were observed to treat residents with kindness and respect, and there was a positive level of interaction between residents and staff. They understood the need to promote dignity through practices such as the way they addressed residents and were seen knocking on bedroom and toilet and bathroom doors before entering. A resident said, “I couldn’t ask for better care. I mostly stay in my room and staff always ‘pop in’ when they pass to ask if I am okay.” Staff were seen to be very gentle when undertaking moving and handling tasks and offered explanation and reassurance throughout the activity. A resident commented, “The carers are lovely. I don’t like being in a home, but the staff make it easy to live here.” People are involved in the planning of their care that affects their lifestyle and quality of life. Some care plans were very detailed, gave a real sense of the individual resident and were very personalised. However, other care plans contained only standardised statements and did not reflect the detail of care being provided. This was particularly noted in the plans of some people who had very complex needs, including dementia and/or learning disability, in addition to their nursing care needs. All care plans should provide a detailed picture of how the needs of people are being met. All staff were able to give a good verbal account of residents’ care needs and spoke in a very person centred way. They demonstrated a good understanding of the residents’ needs and also of the identified risks associated with each individual, such as risk of falling, or indicators that may lead to behaviours that challenged. Whilst care plans were being regularly reviewed, the manager should ensure that reviews are undertaken in a meaningful way and do not become a routine exercise with “no change” being automatically recorded each month. Staff also need to ensure that daily recordings are more in line with the outcomes identified in the care plans, and also that the implications of the Mental Capacity Act 2005 are taken into account in both the care planning and the daily recordings. This was discussed with the manager during the inspection and we also left a copy of the Commission’s guidance on the Mental Capacity Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.R01.S.doc Version 5.2 Page 14 Act 2005. Care plans and diary notes should reflect the changing needs of people in the ways in which their well-being is maintained. Risk assessments are routinely undertaken on admission for all residents around nutrition, manual handling, continence, risk of falls and pressure sore prevention. Risk assessments are being reviewed and updated regularly. Residents are routinely weighed on a monthly basis, or more frequently if a significant risk is identified. Where concerns are indicated there is evidence that appropriate action is taken, with an initial referral to the GP and then to a dietician or nutritionist. The documentation and health records relating to wound management; management of diabetes, and catheter care were examined. Professional advice and input are sought as required from Tissue Viability Nurse; Diabetic Nurse Specialist; Speech and Language Therapist and Continence Nurse Advisor. There was evidence that residents are able to access GP, dental care, chiropody services, optician and other specialist medical services as necessary. A number of monitoring charts were examined including blood sugar monitoring and fluid intake and output charts. These were found to be in good order and being adequately maintained. People’s health is promoted to ensure their continued well-being. There are policies and procedures for the handling and recording of medication. Copies of the policy were available for staff to consult. Medication Administration records showed that the receipt of medication had been recorded. An audit was undertaken of the management of medicines in the home, and a random sample of Medication Administration records (MAR) charts were examined. All medicines for the people case tracked were available for their use. There was a clear and complete record of their medication. It showed that the medication that had been prescribed for them had been administered to them. Separate records were maintained for controlled drugs. We found these were complete and the amount of medication held corresponded with those recorded in the controlled drugs books. Discussions with staff and the review of medication records show that staff are following policies and procedures, so as to ensure that residents are safeguarded with regard to their medication. We found that those residents who have dementia were not prescribed antipsychotic medication. The registered manager explained that, where possible, he tries to use other methods to overcome behavioural issues. We observed staff working with people who have dementia and saw that they involved them in activities. Staff spoken to understood how to support residents whose behaviour can be challenging to the service by, for example, spending time individually with them, or involving them in activities. People are supported by staff to enhance and maintain their well-being. Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.R01.S.doc Version 5.2 Page 15 Where a resident had an allergic reaction to either medication or food this was recorded on the MAR chart and in the care plan. However, it is strongly recommended that where such an allergy has been identified; it is recorded more prominently and highlighted on the front sheet of the resident’s file and on the MAR chart. Allergies should be identified to make sure that residents are safe. Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.R01.S.doc Version 5.2 Page 16 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 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are provided with varied activities to meet their needs. People living at the home are supported to maintain contact with relatives and other representatives of their choice. The menu reflects the preferences of people living at the home and offers them a balanced diet. EVIDENCE: The home employs a part time activity co-ordinator. There is a general programme of activities available and this is now more varied and flexible to suit not only individual’s preferences, but also more appropriate to the capacities of people living with dementia. We observed that staff involved residents who have dementia in one-to-one activities. Records show that regular activities are being provided for those residents who have dementia. There is a limited programme of activities outside the home and the registered Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.R01.S.doc Version 5.2 Page 17 manager has identified this in the AQAA as an area for improvement. One member of care staff told us: “We had a really good trip to Southend last week. About seventeen residents joined in and we had plenty of staff to make sure that everybody had a good day.” We were told that carers are now more involved in activities with the residents, and we observed this during the inspection. People spoken to told us that these activities are provided regularly. Peoples’ interests were recorded as part of their care plans. People are involved in meaningful daytime activities of their own choice and according to their individual interests and capabilities. From talking to residents, relatives and staff and from observations on the day, it was evident that the routines of daily living are flexible to suit the differing needs and preferences of all people living in the home. One resident regularly chooses to get up later in the morning and prefers to have his shower before lunch and we evidenced this on the day of the visit. We observed members of staff allowing time for residents to express their wishes and supporting individuals to make choices in their everyday lives. We observed that staff generally interacted well with residents and demonstrated a good understanding of the differing needs of people living in the home. Residents are supported to make a positive choice about how they wish to live in the home. Visiting times are flexible and relatives and friends are encouraged to visit. We observed visitors being offered hot drinks. Visitors spoken to confirmed that refreshments are routinely offered whenever they visit. We observed that the relatives visited throughout the day. Daily notes showed that people were able to have regular contact with the relatives. Residents are supported to maintain contact with the relatives and representatives. We observed breakfast on the first day of the inspection, and found that some people preferred to have breakfast in their rooms, and others at small tables over their armchair. We also observed the lunchtime meal being served on the second day of inspection. Generally residents were assisted to one of the dining rooms. Other residents took their meal in their rooms according to their individual needs and choices. Dining tables were nicely laid with tablecloths, napkins, cutlery, glasses and condiments. Meals appeared appetising and well presented. Residents were being given choices and asked what they would like to eat. Sufficient numbers of staff were on hand to give the necessary and appropriate level of assistance. Residents’ dietary needs are recorded as part of their care plans (for example if they were diabetic or needed a puree meal), with action taken to address any concerns about dietary intake or weight loss. We observed that meals were well presented in a warm and friendly way. We saw that residents were supported to eat. We observed that this was done at the pace of the residents being assisted. Residents are able to enjoy the food they prefer and like. Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.R01.S.doc Version 5.2 Page 18 A visit was made to the kitchen and we were able to discuss the storage and preparation of food, and menus with the cook and one of the kitchen assistants. There is a daily menu and a record is maintained of what each individual chooses to eat. A full cooked breakfast is available at weekends. Also residents can choose to have cooked eggs every morning, for example boiled, fried or scrambled. Kitchen staff were aware of those residents requiring special therapeutic diets and other diets or foods to meet religious or cultural dietary needs. One resident is provided with Halal food. There is a daily vegetarian option and rice as a carbohydrate, is available at each meal. There are hot and cold meal options at both lunchtime and in the evening. Prepared fresh fruits are available daily and on request. The use of full cream milk, butter and cream is used wherever possible to supplement the diets of those residents with reduced food intake or diminished appetite. Residents are offered a variety of meals that reflect their personal preferences and meet their dietary needs. Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.R01.S.doc Version 5.2 Page 19 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 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are supported to express their concerns, having access to an effective complaints procedure and are protected from abuse. EVIDENCE: The home has a written policy and procedure for dealing with complaints which is prominently displayed throughout the home. Those residents and relatives spoken to were aware of how to make a complaint and to whom, if they needed to. One resident told us: “I spoke to Mr Rashid (the manager) because another resident across the corridor was playing his music quite loud at night – and he sorted it out”. Upon examination of the files the inspector noted an entry on one resident’s file dated 27/6/08, of an incident reported by a relative to a carer, regarding a resident being slapped. Although this was logged in the daily log, there was no entry in the homes incident book. There was no entry of any follow up action taken in either the residents records or the above log. However during the inspection visit to the home one of the inspectors unaware of this incident, spoke to members of this residents family and they expressed no concerns or made any reference to this reported incident. The issue was Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.R01.S.doc Version 5.2 Page 20 also followed up by the placing authority, and the family confirmed that they had no concerns about the resident’s care. We also spoke to a number of visiting relatives. Comments included: “My mother has been a resident here for a number of years. I have had no concerns all this time. On the occasion I have had a small problem I have spoken to Rashid (the manager) and it has been resolved”. No complaints had been referred by the Commission to the home since the last key inspection. Residents are supported to express their views, and concerns in a safe and understanding environment. All staff have undertaken training in safeguarding vulnerable adults and this is included in the induction training for all newly recruited staff. This was evidenced on staff files and training schedules. Those staff spoken to were able to demonstrate a good understanding of the organisation’s policy and procedure in this area and knew what action to take if they had any concerns about the safety and welfare of residents. Staff were also knowledgeable about the different types of abuse and the common indicators of abuse. There is a policy on whistle blowing and challenging bad practice at work. A member of staff told us: “If I saw something wrong I would tell the nurse in charge straight away. If it were a nurse I would speak to the manager or Mrs Ebrahimkhan (one of the registered providers). People feel safe and well supported by the home, which has their protection and safety as a priority. An allegation of abusive practice was made to the Commission for Social Care Inspection, shortly before the inspection took place. The allegations were made by a former member of staff, who had not used the home’s own whistleblowing procedure to raise concerns. The allegations were referred to the London Borough of Redbridge, for consideration under the council’s safeguarding adults procedures. This included examination of information by the local police. Social and health authorities involved in the commissioning of places at the home undertook reviews of their clients’ care to establish if there was any cause for concern. The CSCI inspection also took the nature of the allegations into account when undertaking this robust inspection, and were specifically looking for evidence to substantiate the allegations of poor or abusive practice. No evidence was found to substantiate any of the allegations by any of the agencies involved. However, the registered providers confirmed that they would undertake a review of some areas of practice, such as ensuring that all care plans and daily records were sufficiently detailed to enable staff to care for residents in a consistent and high quality manner, and that there is more evidence to demonstrate the action taken to follow up unexplained bruising or injuries sustained when a resident is found to have fallen or hurt themselves. The registered providers worked co-operatively and openly with all agencies investigating the safeguarding adult concerns. Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.R01.S.doc Version 5.2 Page 21 Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.R01.S.doc Version 5.2 Page 22 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 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is designed to enable residents to live in a safe well-maintained comfortable environment that supports their independence. EVIDENCE: We did a tour of the premises, at the start of the visit; accompanied by one of the nursing staff and all areas were visited again during the day. Communal areas and many of the residents’ bedrooms were also observed during the visit on 5th September. Overall the home is welcoming, clean, well lit and tidy. Odour control and cleanliness throughout the home was good, including the Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.R01.S.doc Version 5.2 Page 23 early morning visit of 5th September. There are a number of lounges and dining rooms on both the ground and first floor. There is one lounge/ dining room on the smaller top floor. The layout of the furniture in the main ground floor lounge and dining room was more homely and appropriate to the specific needs and lifestyle of residents. Some bedrooms were seen by invitation of the resident, whilst others were seen because the doors were open or rooms were being cleaned. All of the bedrooms seen were very personalised and reflective of the occupant’s culture, religious and personal interests. There is a programme for the continued and ongoing decoration and refurbishment of the home. Since the last inspection a number of improvements have been made to the general environment. This includes: new showers fitted to the top and ground floor bathrooms; flat screen televisions and DVD players for lounges; improvements to the patio area; replacement and provision of specialist equipment such as reclining chairs and hoists and new gates to the rear of the premises for improved security and more appropriate external enclosures for household and clinical waste. There are adaptations and equipment in place that are capable of meeting the needs of all residents. We observed that residents were able to access all areas in the home safely. The home has the necessary adaptations to support people to move around safely. There are adapted bathrooms and toilets on each floor. These are accessible to residents who have mobility difficulties. Hoists were available on all the floors. The home provides an accessible environment for residents. We visited the laundry and this was found to be clean, with soiled articles and clothing being stored appropriately pending washing. Hand washing facilities and alcohol hand sanitisers are prominently sited. Staff were observed to be practising an adequate standard of hand hygiene and control of infection. Staff confirmed that they had access to disposable gloves and aprons. Staff spoken to understood how to work to minimise the possibility of cross infection. Effective infection control measures are in place to ensure the safety of people living at the home. Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.R01.S.doc Version 5.2 Page 24 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 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Sufficient staff are available to meet the needs of people who live at the home. Staff have the skills to meet the assessed needs of people who live at the home. People who live at the home are protected by the home’s recruitment practices. EVIDENCE: We inspected staff rotas and the overall staffing levels and skill mix of qualified nurses and care staff across the three floors were sufficient to meet the assessed nursing and personal care needs of the residents. Staff were being effectively deployed to ensure that residents choosing or needing to remain in their bedrooms were being cared for appropriately. Staff said that the current staffing level allowed them to meet the needs of residents. We observed that sufficient staff are available to provide one-to-one support for residents, particularly those who have dementia. There are enough staff available to meet the needs of people throughout the day. Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.R01.S.doc Version 5.2 Page 25 Effective team working was observed throughout the visit and staff were interacting well, both with each other and the residents. A senior care assistant who has worked in the home for a number of years told us: “We are working together as a team – nurses and carers. Communication between everyone is good”. Team working makes sure that the needs of residents are met in a consistent way that supports their well-being. We inspected a sample of staff files, including the most recently recruited staff. These were found to be in good order with necessary references, enhanced Criminal Records Bureau (CRB) disclosures and application forms duly completed. A valid Nursing and Midwifery Council (NMC) PIN and statement of entry is obtained and validated for qualified nursing staff. All elements of recruitment are accurately recorded and all required documentation is obtained prior to the commencement of employment. The registered providers are able to demonstrate that they operate a proactive recruitment procedure in line with equal opportunities. Robust recruitment procedures are followed to ensure the safety and well being of people. The registered providers employ a workforce from diverse cultures and backgrounds. In discussion with staff they were able to demonstrate an awareness of the importance of understanding and appropriately meeting the needs of all residents, wherever possible around equality and diversity issues. This awareness is reinforced through staff training and supervision. This was identified throughout the AQAA as an essential part of staff development and practice within the home. People are well supported by a staff team that recognises and responds appropriately to their diverse needs. Staff whose first language was not English were able to understand and communicate adequately in English. Languages spoken by the staff team enabled many of them to communicate in the first language of people who live at the home. The AQAA stated that approximately 80 of care staff are qualified to National Vocational Qualification (NVQ) level 2 or above, and seven other members of staff are currently working towards this qualification. We looked at the current staff training records which showed that staff have received training in essential areas such as fire safety, food hygiene, moving and handling, infection control and safeguarding vulnerable adults. Other training undertaken includes palliative care, understanding dementia, cultural awareness, pressure area care and wound management. Some staff have received training in the Mental Capacity Act 2005, and its implications on the delivery of care to vulnerable people. Staff spoken to said that training was given a high profile by the manager and that there were ample opportunities for staff to improve their skills and knowledge in line with residents’ changing needs. The home ensures that all staff receive relevant training that is focused on delivering improved outcomes for residents. Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.R01.S.doc Version 5.2 Page 26 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 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Appropriate management structures are in place to ensure that people receive the care they need. People who live at the home are consulted about the quality of the service, and encouraged to make suggestions for improvement. People who live at the home have their financial interests protected by the home’s procedures. People who live at the home and staff are protected by the home’s health and safety procedures. EVIDENCE: Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.R01.S.doc Version 5.2 Page 27 The registered manager is also the joint proprietor of the home and is a qualified nurse. He has the skills, qualifications and experience to manage the home. He has a clear understanding of what further improvements are needed and the key areas which need further development. The AQAA clearly identifies the plans for improvement to the service over the next twelve months. In discussion with nurses, care staff and ancillary staff it was evident that they felt well supported by the registered manager. They demonstrated a commitment to ensure that they continued to work as a team for the benefit of the residents and to provide a high standard of care. Staff spoke very highly of the registered manager. They said they felt well supported and received clear directions and leadership. The registered manager has a clear understanding of how to deliver good outcomes for people living at the home. The responsible individual undertakes monthly Regulation 26 monitoring visits to monitor and report on the quality of the service being provided to people living in the home. A copy of the report is made available to the Commission. The home has a system for obtaining the views of the quality of the service it provides. The home makes sure that any areas for improvement are addressed. Residents who have capacity, and relatives of residents are encouraged to participate in determining the future development of the service. Currently the manager does not act as an appointed agent for any resident. Residents’ financial affairs are managed by the individual resident, or their representatives. The home has responsibility for the personal allowance of one resident. Secure facilities are provided for the safe keeping of money and valuables held on behalf of residents with written records being maintained. Residents who use the service can have confidence in the home’s procedures for handling their money safely. A wide range of records were looked at including fire safety, emergency lighting, water safety temperature checks and call alarm system These records were found to be in good order and up to date. The home has a consistent record of meeting the relevant health and safety requirements and closely monitors its own practice. All health and safety policies were available. Certificates for gas, Legionella and electrical testing were in date. We questioned staff on the fire safety procedures and found that they understood fire safety issues. Health and safety checks, procedures and training make sure that residents are safe. Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.R01.S.doc Version 5.2 Page 28 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 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 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 Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.R01.S.doc Version 5.2 Page 29 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The registered persons should make sure that all care plans are sufficiently detailed and provide guidance on how the needs of residents will be met. Care plans should provide a detailed picture of how the needs of people are being met to ensure their well-being. The reviews of care plans should demonstrate more effectively the detail of the review process. The registered persons should make sure that diary notes detail the care that is being provided to residents. The care provided to residents needs to be monitored effectively to make sure they receive the care they need. The registered persons should make sure that any allergies that residents have are recorded in the medication records. Allergies should be identified to make sure that residents are safe. 2 OP7 3 OP9 Cambridge Nursing and Residential Care Home (The) DS0000037315.V372612.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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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