Care Home: Cerne Abbas Care Home

What the care home does well There was evidence that residents receive the care they need from staff who are kind and competent. Care plans and associated records provide staff with sufficient guidance to enable them to properly care for and protect residents from the harm and ill health that unplanned and potentially inappropriate care might cause. What the care home could do better: An extensive programme of cleaning, maintenance and refurbishment must be commenced to ensure the continued safety and suitability of the premises. Some aspects of medicine handling and record keeping must be improved to ensure that residents receive the medicines they have been prescribed in correct amounts, and that records provide reliable evidence of medicine handling. To comply with the Regulations associated with the risks posed by potentially unsuitable staff, evidence of the decision to employ, or not employ, job applicants should be available for inspection. The post of registered manager has been vacant since early January 2008; a number of Acting Managers have subsequently taken charge of the home but to date no application has been made for a manager to be registered with us. On 25 June 2008 we wrote to the home advising that the Care Homes Regulations 2001, Regulation 8(1) requires the appointment of an individual to manage a care home. Further to this, Regulation 9(1) states that a person shall not manage a care home unless he is fit to do so. We stated that you must make application to register any person appointed to manage the home at the earliest opportunity to comply with Section 11(1) of the Care Standards Act 2000, because if the Registered Manager is temporarily absent you can only rely on temporary management arrangements for up to 6 months. Resolution of this matter is now long overdue so in order that we may determine your compliance with the regulations, please tell us about the interim management arrangements in place prior to the registration of a manager with the Commission. This should include the name of the individual undertaking responsibility for the day to day management of the home, period covered by these arrangements, proof of fitness of the named individual and details of background, skills and experience. This may be in the form of proof of the person`s identity including a recent photograph, a copy curriculum vitae or job application form, copies of two references, confirmation that you have received an enhanced disclosure from the Criminal Records Bureau. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Cerne Abbas Care Home Cerne Abbas Care Home Cerne Abbas Dorchester Dorset DT2 7AL new service which has yet to be given a quality rating The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Gloria Ashwell Date: 1 6 0 3 2 0 0 9 Information about the care home Name of care home: Address: Cerne Abbas Care Home Cerne Abbas Care Home Cerne Abbas Dorchester Dorset DT2 7AL 01300341008 01300341111 cerne.abbas@ashbourne.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ashbourne (Eton) Limited care home 66 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Conditions of registration: 40 26 The maximum number of service users who can be accommodated is 66. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia aged 55 years and over on admission (Code DE) maximum 40 places Mental disorder, excluding learning disability or dementia (Code MD) maximum 26 places Date of last inspection Brief description of the care home Cerne Abbas Care Home is situated on the outskirts of the village of Cerne Abbas in West Dorset. It is within reasonable walking distance of the village centre with amenities including a post office, church, public houses and tea-rooms. There is a GP practice in the village. Care Homes for Older People Page 2 of 12 Brief description of the care home Car parking spaces for visitors are provided at the rear of the home. A public transport bus service serves the village of Cerne Abbas, neighbouring villages and the nearest towns (Dorchester and Sherborne). The home is registered to provide specialist nursing care for 53 older people with dementia and 18 younger adults who have acquired brain injury including Huntingtons Disease. This report relates to all the 3 units, known as `Houses?. The part of the home delivering care to the younger adults is Cloisters House, situated on the first floor. A passenger lift provides access to the House. The parts of the home delivering care to the older persons are on the ground floor: Orchard House and Atrium House, each with lounge and dining areas. Electronic number keypads are used on the doors leading to each House. The home provides nursing and care staff on a 24-hour basis and employs catering, domestic and maintenance staff. In addition to the nursing, personal care and accommodation provided, the scale of charges for the home includes the provision of social activities, catering for all meals and laundry and housekeeping services. Fees are charged weekly; the fee range quoted in the service user guide at the time of inspection was #550 - #750 per week on Atrium House or Orchard House, and between #800 and #1500 for residents accommodated on Cloisters House. Up to date fee information may be obtained from the service. Information regarding the subjects Value for Money and Fair Terms in Contracts can be obtained from the web link: www.oft.gov.uk A report entitled Care Homes in the UK - A Market Study is available on web link: http:/www.oft.gov.uk/NR Care Homes for Older People Page 3 of 12 What we found: This random unannounced inspection was carried out by two inspectors, in response to information received indicating possible concerns regarding the standard of care afforded to some residents, and the numbers of staff on duty to provide care. The care records of 4 people who live at the home were examined and found to contain risk assessments forming the basis for care plans and daily records describing the care of each person. The records we examined related to at least one person from each of the 3 units, Cloisters, Atrium and Orchard. We found that the standard of record keeping is good with clear and up to date care plans and associated records providing staff with sufficient information upon which to base their practise and being evidence that the people received the care they needed. For medicine handling the home uses a monitored dosage system, whereby most medications are stored in blister packs, to simplify the process of administration. From examination of a sample of Medication Administration Records (MARs) identified a small number of areas where improvement is necessary. For two people medicine administration records indicated that on one occasion each had received a dose of prescribed medicine, additional to the prescription instruction e.g. one person was prescribed Metronidazole 2 x 5mls, 3 times a day, but the MAR shows it was given 4 times on 13.3.09. The other person was prescribed Risperdal 1 ml twice a day, the MAR shows it was given 3 times on 13.3.09. It was also noted that when a variable dose is prescribed, for example Give one or two tablets, the amount actually given is not always recorded, so accurate audit cannot be carried out, and it is not known how much of a particular medicine the resident has received. During our visit, from direct observation there was evidence that the dignity of residents is preserved by staff who were observed carrying out personal care tasks in a discrete and respectful manner. We toured the three Units and gained the overall impression that the home is becoming shabby and in urgent need of general improvement to ensure the suitability of the premises. For example, the following were observed. Cloisters Unit. Bedroom 17 en suite hygiene facility with section of MDF boarding unpainted and thereby not impervious to fluids. Section of metal radiator casing disconnected and lying on floor. Bedroom 20 ensuite hygiene facility foul smelling, bed poorly made with soiled bed Care Homes for Older People Page 4 of 12 linen. Used slippers on floor, but indications that the room currently vacant. A heavily stained urine bottle was on the floor. The casement style window cannot be fully closed and the lock is broken. Bedroom 22 toilet needs cleaning to remove heavy staining. Untreated section of MDF is chipped. Bed had been made with partly wet sheets and pillows. Bedroom 25 double glazing falling out of window frame so serving no useful purpose, and making it hard to open the window safely. A nearby communal use bathroom had a soiled rubber mat in the bath. Corridor handrails had chipped paintwork and many areas of walls show scuff damage. The fridge in the dining room kitchenette was well stocked but floors and cupboards very dirty. The kitchen sink leaks from the U-bend, with an ice cream container catching drips, which was foul smelling with a debris build up indicating a long standing problem. The door leading to the corridor has not been made good after handle relocated. Bedroom 12 window cannot be fully closed. Bedroom 11 contained an armchair in a poor state of repair. Bedroom 9 has a ceiling stained from water ingress, the roof above has previously leaked but the decor appears unimproved since 2008. The toilet seat was very loose and thereby may be hazardous to use. Hand towels were heavily worn, discoloured and starting to fray. Atrium Unit .A strong odour of stale urine permeated the entrance to the unit. The lounge contained a stained armchair with no seat cushion. Many chairs look heavily worn. A cleaner was seen to be operating an electrically powered carpet cleaner despite two residents wandering about including repeatedly stepping over the cable. The toilet off the main lounge has the main extractor fan not working, the one that did work merely extracted the air into the lounge. Bedroom 6 contained cleaning materials including a trolley and machines, although it is used to accommodate a resident. The wardrobe in the bedroom had a strong unpleasant odour, paintwork of the radiator cover was blistered and linen on the bed was stained although recently laundered. In the nearby corridor the air freshener was not operating because the capsule was empty. Bedroom 4 has a window that cannot be fully closed and a sticky floor in the ensuite Care Homes for Older People Page 5 of 12 hygiene facility. Bathroom B1 had a dirty floor and stained bath. Bedroom 3 had misshapen and lumpy pillows on the bed, a water leak in the ensuite hygiene facility, the door to the corridor does not close to latch and the window cannot be fully closed. Bedroom 2 ensuite hygiene facility has a heavily stained floor from previous water leaks. Bedroom 8 contained an armchair without a seat cushion. The toilet pedestal in room 3B stands on an untreated wooden board which is not impervious to fluids and thereby cannot be properly cleaned. One of the two courtyard areas is not used by residents, but had a continuously eaking overflow pipe and a generally uncared for appearance. The courtyard garden between the Atrium cafe area and Orchard Unit has become overgrown with pointed, sharp plants etc and is thereby not fit for residents to enter. Orchard Unit. The door to the sun lounge was locked, the room is apparently being refurbished and is currently without floor covering. In the corridor some curtains were falling from the rail. The communal use bathroom has no working bath, the one that is in the room is not connected to plumbing. We had received information indicating concerns that staffing levels do not ensure that at all times sufficient staff are available to properly meet the needs of residents. We have subsequently been informed that arrangements are in hand to employ additional staff as soon as possible. In this regard we urge you to seek to employ additional nurses trained in mental health nursing, to ensure that guidance in this specialty is routinely available to inform care planning and the provision of care. The records of 3 recently employed staff were examined and found to contain most essential information including written references, interview assessment, health details and evidence of identity. For each of these persons a Criminal Records Bureau (CRB) disclosure had been obtained in advance of employment. Some weaknesses in recruitment practise were found including the following. Each prospective employee completes an application form giving details of past employment. Although details of previous employment were provided by each of the 3 persons whose recruitment records were examined, it was noted that on occasion only the years on which previous employment commenced and ceased were recorded. We Care Homes for Older People Page 6 of 12 recommend full employment dates to be recorded enabling an accurate history to be established. For one of the applicants there were indications that the Criminal Records Bureau disclosure may contain important information, but the document was not available to us to examine, and we were informed it was kept at the head offices of the provider organisation. The records held at the home for this person did not contain a record of interview so we were unable to gain further information in this regard. What the care home does well: What they could do better: An extensive programme of cleaning, maintenance and refurbishment must be commenced to ensure the continued safety and suitability of the premises. Some aspects of medicine handling and record keeping must be improved to ensure that residents receive the medicines they have been prescribed in correct amounts, and that records provide reliable evidence of medicine handling. To comply with the Regulations associated with the risks posed by potentially unsuitable staff, evidence of the decision to employ, or not employ, job applicants should be available for inspection. The post of registered manager has been vacant since early January 2008; a number of Acting Managers have subsequently taken charge of the home but to date no application has been made for a manager to be registered with us. On 25 June 2008 we wrote to the home advising that the Care Homes Regulations 2001, Regulation 8(1) requires the appointment of an individual to manage a care home. Further to this, Regulation 9(1) states that a person shall not manage a care home unless he is fit to do so. We stated that you must make application to register any person appointed to manage the home at the earliest opportunity to comply with Section 11(1) of the Care Standards Act 2000, because if the Registered Manager is temporarily absent you can only rely on temporary management arrangements for up to 6 months. Resolution of this matter is now long overdue so in order that we may determine your compliance with the regulations, please tell us about the interim management arrangements in place prior to the registration of a manager with the Commission. This should include the name of the individual undertaking responsibility for the day to day management of the home, period covered by these arrangements, proof of fitness of the named individual and details of background, skills and experience. Care Homes for Older People Page 7 of 12 This may be in the form of proof of the persons identity including a recent photograph, a copy curriculum vitae or job application form, copies of two references, confirmation that you have received an enhanced disclosure from the Criminal Records Bureau. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 12 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 (2) The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This means that all medications/medicines must be administered only to the person for whom they have been prescribed and dispensed. 07/07/2008 2 26 23 (2) The registered person shall 07/08/2008 ensure that the premises are kept in a good state of repair and all parts of the care home are kept clean. Care Homes for Older People Page 9 of 12 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home.This means that an accurate record of each instance of medicine administration must be kept for each resident. 25/04/2009 2 19 23 The registered person shal, 25/04/2009 having regard to the number and needs of service usders ensure that the presmises are kept in a good state of repair and are kept clean and reasonably decorated. The registered provider shall 25/06/2009 appoint an individual to manage the care home and shall give notice to the Commission of the person so appointed and the date on which the appointment is to take effect. 3 38 8 Care Homes for Older People Page 10 of 12 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 19 An extensive programme of maintenance and refurbishment should be commenced to ensure the continued safety and suitability of the premises. For each applicant full employment dates should be recorded enabling an accurate history to be established and there should be details of interview and the information regarding the decision to employ or not employ. 2 29 Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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