Care Home: Cooksditch House Nursing and Residential Home

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What the care home does well Cooksditch House Nursing and Residential Home DS0000023399.V377726.R01.S.doc Version 5.2 People can be confident that their needs will be properly assessed prior to moving in so as to ensure that their needs can be met. People benefit from an effective manager and caring staff who support them appropriately. Service users are protected by effective medication administration and procedures. People are supported with their individual healthcare needs. Relatives and friends are encouraged to visit and are able to give their opinions on the home. What has improved since the last inspection? Care plans are now more reflective of individual choices and preferences including preferred times of getting up and going to bed and particular likes and dislikes for meals. Risk assessments are now more detailed and support people in ensuring risks are reduced. People are supported with their individual health care needs. The home has arranged for people to attend a social evening in the home on Friday nights which gives people the opportunity to take part in quizzes and music evenings. An improvement and maintenance plan has been implemented and parts of the home has benefited from refurbishment. The improvement and maintenance plan identifies continued refurbishment works with scheduled target dates between October and December 2009. The environment will further benefit from this. What the care home could do better: Time spent with individual people is sporadic, with some people benefiting from one to one time more than others. The support provided at meal times need to be kept under review Staff deployment on occasion meant that there were no available staff on the ground floor for people if they needed assistance. Staff communication needs to be monitored and improved so that does not become a regular occurrence. Mental health and mental capacity needs are assessed, but this needs to be more robust so as to ensure individual needs can be fully met. Staff would benefit from the development of the training and induction programme and further structured supervision.Cooksditch House Nursing and Residential HomeDS0000023399.V377726.R01.S.docVersion 5.2 Key inspection report CARE HOMES FOR OLDER PEOPLE Cooksditch House Nursing and Residential Home East Street Faversham Kent ME13 8AN Lead Inspector Anne Butts Key Unannounced Inspection 17th September 2009 10:45a DS0000023399.V377726.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Cooksditch House Nursing and Residential Home DS0000023399.V377726.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Cooksditch House Nursing and Residential Home DS0000023399.V377726.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cooksditch House Nursing and Residential Home Address East Street Faversham Kent ME13 8AN 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) 01795 530156 Mrs Gillian Ilsley Ms Rosemary Harwood Care Home 55 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Cooksditch House Nursing and Residential Home DS0000023399.V377726.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP). 2. The maximum number of service users to be accommodated is 55. Date of last inspection Brief Description of the Service: 26th January 2009 Cooksditch House is a large detached property situated in the centre of Faversham. The original house is a grade 2 listed building. It offers care for up to 55 people. The home can accommodate people with residential or nursing needs. It is not registered for people with a diagnosis of dementia. The home consists of two parts, the main house, which is the original building (known as Wing 1) and has nineteen bedrooms and an extension (known as Wing 2) and has thirty one bedrooms. Accommodation is provided in with 45 single and 5 double rooms many of which offer ensuite facilities. Double rooms are only offered to people who have made a positive choice to share. Buses stop outside the Home. There is a local park and church within a few minutes walk of the Home. The Home has two lifts to enable access to all the areas. The fee range for residential is £500.00 and £650.00 for nursing care. The home is currently only offering accommodation in Wing 2. Cooksditch House Nursing and Residential Home DS0000023399.V377726.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 a key unannounced inspection which took place over the course of one day and was carried out by two inspectors. We (the Care Quality Commission) were in the home from approximately 10.45 in the morning until 7.00 in the evening. Time was spent looking at the environment, talking to the registered manager, staff, people living in the home and relatives who were visiting on the day of our inspection. We also looked at a selection of records including assessments, care plans, medication, healthcare and staff records. An Annual Quality Assurance Assessment (AQAA) had been sent to us prior to our visit. The AQAA is a self-assessment, required by law. This assessment focuses on how the service considers they are meeting the outcomes of the people using the service and where it feels it can make improvements. It also provides statistical information about the service. Information from the AQAA has been used in this report where appropriate. The AQAA contained all the information we asked for. Through sharing information protocols under safeguarding vulnerable adults procedures we have also reflected information provided by other statutory bodies. Judgements have been made with regards to each outcome area in this report, based on records viewed, observations and verbal responses given by those people who were spoken with. These judgements have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable us (the Care Quality Commission) to be able to make an informed decision about each outcome area. At the time of our visit the home was only partially open with twenty four people living in the home. The main house (Wing 1) was closed due to refurbishment works and low occupancy levels. People who remained in the home and had been living in the main house (Wing 1) had now moved into Wing 2. We did not inspect the main house. Judgements have been made in this report in relation to the service provided at the current service level on the day of our visit. It is the registered providers responsibility to inform us (the Care Quality Commission) when the service level changes and the home is once again providing accommodation to people in both Wings. What the service does well: Cooksditch House Nursing and Residential Home DS0000023399.V377726.R01.S.doc Version 5.2 Page 6 People can be confident that their needs will be properly assessed prior to moving in so as to ensure that their needs can be met. People benefit from an effective manager and caring staff who support them appropriately. Service users are protected by effective medication administration and procedures. People are supported with their individual healthcare needs. Relatives and friends are encouraged to visit and are able to give their opinions on the home. What has improved since the last inspection? What they could do better: Time spent with individual people is sporadic, with some people benefiting from one to one time more than others. The support provided at meal times need to be kept under review Staff deployment on occasion meant that there were no available staff on the ground floor for people if they needed assistance. Staff communication needs to be monitored and improved so that does not become a regular occurrence. Mental health and mental capacity needs are assessed, but this needs to be more robust so as to ensure individual needs can be fully met. Staff would benefit from the development of the training and induction programme and further structured supervision. Cooksditch House Nursing and Residential Home DS0000023399.V377726.R01.S.doc Version 5.2 Page 7 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Cooksditch House Nursing and Residential Home DS0000023399.V377726.R01.S.doc Version 5.3 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 Cooksditch House Nursing and Residential Home DS0000023399.V377726.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5 and 6. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given appropriate information about the service and can be confident that their needs will be assessed prior to moving in. EVIDENCE: There is an updated Statement of Purpose in place and this contains all the information that people would need to know about living in the home. The registered manager told us that this is also available is large print should anybody request this. Since our last key inspection the occupancy levels have decreased with people currently only occupying Wing 2 of the building. There has only been a limited amount of new people move into the home. We spoke to the registered manager about the assessment process for prospective new service users. She told us that she will visit a person prior to them moving in the home and carry out a full assessment of need. She also told us that Cooksditch House Nursing and Residential Home DS0000023399.V377726.R01.S.doc Version 5.3 Page 10 she will access the support of appropriate healthcare professionals to ensure that the home can meet the needs of the prospective service user. Records seen showed that people are appropriately assessed by the home prior to moving in. Assessments looked at risks, personal history and preferences including normal routines before moving in and health needs. People are given the opportunity to visit the home prior to moving in and encouraged to visit and look around the home. We spoke to the relative of a person who had moved into the home in June. He told us that staff at the home had been helpful during the admission procedure. He said that they were able to visit the home prior to moving in and once his relative had moved in, then they had settled in within a week. The home does not provide intermediate care, which is recuperative care for people enabling them to return home. They do, however, on occasion offer respite care for people. Cooksditch House Nursing and Residential Home DS0000023399.V377726.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from care plans which are aimed at supporting them in meeting individual needs. Health needs are met and service users benefit from having full access to all professional health care services as required. EVIDENCE: We looked at the care plans and risk assessments for six service users. Since our last visit the registered manager has arranged for files to be reorganised and updated into a format that was easier for staff to use and navigate. We saw that the care plans were now more person centred, reflected individual needs and identified how to support people with activities of daily living. Many areas of the care plans we viewed now gave clear guidance on how to support people with their individual needs. Cooksditch House Nursing and Residential Home DS0000023399.V377726.R01.S.doc Version 5.3 Page 12 For example one part of a care plan identified that sometimes a person would sometimes refuse meals, but gave clear steps on action to take and procedures to follow to support this person with their nutritional needs. Care plans were indicating that people are now involved in the care planning process and staff we spoke to who formulated the care plans confirmed that they would speak to the individual person in relation to their preferences and choices and aim to present a care plan which met their needs within a risk assessed framework. Risk assessments are more proactive in giving guidance for the safe management of risks. For example movement and handling risk assessments clearly identified if a hoist and sling were needed, and which piece of equipment. They identified if the person needed assistance with one or two members of staff and also if the person could assist in any way for themselves. There are additional risk assessments in place to support with nutrition, falls, skin integrity and mental capacity. There is a dependency risk summary in place in each file, which is used to record the re-evaluation of risks and monitor changes. We saw that these had not been updated in all cases, and this needs to be addressed. Health care needs are identified and significant medical histories identified. Records showed that there are nationally recognised screening tools in place including the MUST tool (which is for nutritional needs) and the waterlow tool (which is for skin integrity). Blood sugar levels and diabetic needs are monitored. The home seeks the assistance of relevant healthcare professionals and people have access to the GP, dentist, chiropodist and district nurses. One family member told us that their relative is supported to visit the local health care centre and is escorted by staff. It was noted that people with diabetes were paying privately for their chiropody service. The manager was informed that people who have diabetes should be entitled to a free NHS chiropody service and we have been told that the home do make a referral to the Primary Care Trust (PCT) and the home should evidence that they have supported people to do this if that is their wish. The registered manager has embedded a named nurse and key worker system into the home so that there are allocated staff who will take responsibility for supporting people with purchasing toiletries, clothes and helping out with tidying their personal belongings in their rooms. There is a care plan agreement in place with the individual person and also an agreement for the use of bedrails. We saw that these were sometimes signed by relatives, but with no indication as to whether the service lacked capacity to make these decisions. We spoke to the registered manager about this and she needs to ensure that where people have capacity then relatives should not be signing on their behalf. We looked at how people are supported with any behavioural needs and saw that there are assessments in place and monitoring records that identify any changes in behaviour. Mental health and mental capacity needs are assessed. We identified inconsistencies in the mental capacity assessment process, with two assessments being in place and in at least two care plans contradicted each other. For example one assessment stated that the person did not have capacity and there was no supporting care plan in place, but another Cooksditch House Nursing and Residential Home DS0000023399.V377726.R01.S.doc Version 5.3 Page 13 assessment in the records identified the person as having capacity. We spoke to the registered manager who agreed that this would be addressed. Care plans identified how to support people with their privacy and dignity and reflected individual likes and dislikes. The arrangements for support with health and personal care ensured that peoples privacy and dignity was respected at all times. People we spoke to all said that staff were kind, courteous and respected them. Medication administration and record keeping was looked at. The home has effective procedures in place for administering medication and good storing and record keeping. A medication round was observed and this showed that staff followed good practice when administering medication and showed respect and sensitivity to people at all times. All staff who administers medication receives regular training. We have been informed that staff receive annual competency assessments, records need to be maintained to fully evidence this. Cooksditch House Nursing and Residential Home DS0000023399.V377726.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a range of social activities but the further development of these would benefit people living in the home. Residents are supported to maintain contact with family and friends, The meals provided in this home are good and offer choice; variety and cater for special dietary needs. EVIDENCE: There is a range of activities available for people to participate in. The home employs a part time activities co-ordinator who arranges different events. Group pastimes include film afternoons or evenings, games and musical entertainment. The home has arranged for a ‘social club’ event to take place on Friday nights which people can attend if they wish and take part in quizzes and music evenings, drinks and snacks are available at this. Larger events have included a summer fete, in which all service users were encouraged to participate in and the home was visited by Morris dancers earlier in the summer. Some Cooksditch House Nursing and Residential Home DS0000023399.V377726.R01.S.doc Version 5.3 Page 15 people benefited from an outing to the coast and other people also visit the local Age Concern day centre. Individual activities lacked structure, however, and although care plans identified individual needs such as spending time on a one to one basis records did not show that this was a regular event. One person told us ‘I can’t be bothered with activities, sometimes when the girls have chance they will come in and talk to me’. Another person showed us a jigsaw they were working on and pictures they had made. On the day of our visit the activities coordinator was not working, and we observed that there was no organised time spent with people. Staff were busy with care and support needs and had little time opportunity to spend quality time with people. The Annual Quality Assurance Assessment stated that there are plans to further develop evening activities and also use volunteer input, which would give people more opportunity to participate in activities of their choice. The registered manager confirmed at our visit that she is further looking at developing individual activities. Visitors are welcome at any time and are able to stay as long as they wish. One visitor told us ‘I am happy that my relative is in here, they are very supportive and I can visit when I want’. People told us that they had a choice about how they spent their day and also could choose when they wanted to go to bed or get up. One person told us ‘I generally like to go to bed at around 10.00 and I usually get up around 7.00 and this suits me’. Care plans indicated people’s preferences including information on both social and care support. All special diets are catered for and menus showed that there are a variety of home cooked meals which gave people a choice. The cook told us that she would visit people with the menu choice so that they were able to choose. People we spoke to confirmed that this happened. There are records held in the kitchen which identify individual needs such as a diabetic diet or the consistency of the food to be served. Preferences and individual abilities are identified. Choices of drinks are made available and people are asked which they would prefer. Snacks and drinks are available throughout the day. The main lunch time meal is a cooked meal and the evening meals consists of a choice of hot and cold snacks. People we spoke to said that the meals were nice. One person said ‘the meals are always food and I have put on weight since I moved in here’ and another person said ‘I really enjoy the meals’. We observed the lunch time meal in the dining room. On the day of our visit this was a disjointed, and at times, hectic event. Prior to everyone being seated ready for their lunch, some staff had started to give out meals. Some of these people needed full assistance and at one point a carer was observed to be assisting three people with their meals, and moved between tables to help different people. Once everyone was seated and all meals had been given out, there were ten people who were eating in the dining room, five who needed full assistance and three people who needed some support. Once the meals had been given out and further meals taken to people who were in their rooms the meal time became more of a sedate affair with more staff available to assist individual people. We spoke to the registered manager about this, who said that this was not normal practice and she would be investigating this. Some Cooksditch House Nursing and Residential Home DS0000023399.V377726.R01.S.doc Version 5.3 Page 16 people needed to wear an apron to protect their clothes from spillages and people were provided with blue plastic disposable aprons. The home may want to consider their use of these as they do not fully promote peoples dignity. Meal times are an important social event and the home needs to ensure that meal times are respected. Cooksditch House Nursing and Residential Home DS0000023399.V377726.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a complaints procedure and service users and relatives feel their views are listened to and acted upon. The home has responded to safeguarding concerns and taken positive action to protect the people living in the home. EVIDENCE: There is a complaints procedure in place and this is available to all service users and other stakeholders. The registered manager told us that there had been no complaints since our last visit. We spoke to people living in the home and they told us that they had no concerns. We also had the opportunity to speak to three relatives. They told us that they had no complaints and if they had any concerns they were confident in speaking to the registered manager. One person told us they had some minor issues, but had spoken to the registered manager and these had been resolved and not re-occurred. One relative told us that they felt ‘the home operated in an open and transparent manner which kept them fully informed of how the home was running’. We (the Commission) have not received any complaints about the service. The home has been subject to a safeguarding vulnerable adult’s investigation in line with Kent and Medway Adult Protection Protocols. This investigation has now been closed. We saw evidence at our visit that the registered manager had worked closely with the safeguarding team. Cooksditch House Nursing and Residential Home DS0000023399.V377726.R01.S.doc Version 5.3 Page 18 Staff training in adult protection is not fully up to date and needs to be addressed. We spoke to members of staff and they told us that they would report any concerns to the registered manager. Cooksditch House Nursing and Residential Home DS0000023399.V377726.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24 and 25. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from having their own rooms, which they are able to personalise. The furnishings and carpets in the communal areas show signs of wear and tear and will benefit from replacement and refurbishment through the scheduled improvement plan. EVIDENCE: Cooksditch residential and nursing home is situated on a main road in the centre of Faversham. It is close to local shops and has good road, rail and transport networks. There is limited parking available at the rear of the building. The building consists of the original house, which is a listed building and an extension. At the time of our visit the original house was not in use and had been closed to residents. Cooksditch House Nursing and Residential Home DS0000023399.V377726.R01.S.doc Version 5.3 Page 20 We did not look at this element of the building as part of our inspection. We were told that there are plans to re-open this part of the home. The part of the building which is currently in use is laid out over two floors and consists of thirty one bedrooms (fifteen of which are en-suite), a large communal sitting room and a dining area. There is also a small quiet lounge area, although there are plans to develop this into a hairdressing area. There are a small number of bedrooms which can accommodate a shared facility, but currently all bedrooms are in use as single occupancy only. There are also toilet and bathroom facilities. Additional facilities include the kitchen, laundry, sluice and medication rooms. Access to the second floor is via a lift or stairs. There are gardens to the front of the home and these have recently been cleared and there are further plans to relay a new lawn. At the rear of the building there is outside patio space and a seating area for residents and their visitors. There is a suitable ramp at the main entrance to allow for ease of access for people in wheelchairs or with mobility difficulties. We looked at a selection of bedrooms and saw that they were clean and people are able to have their own possessions and personalise their rooms. Own furniture can be brought in, in agreement with the home. The Statement of Purpose says that if a bedroom is in need of redecoration, prior to someone moving in, or whilst they are living in the home then people will be given a choice with regards to the colour of the room. The Statement of Purpose also states that some rooms have telephone points and we saw that one lady had arranged for a telephone to be installed. We spoke to four people and asked them if they were happy with their rooms, they all said they were. One person said ‘it is kept clean and I have no complaints about my room’. Individual bedrooms had equipment suitable for peoples needs including adjustable beds and airwave mattresses if people had been assessed as needing these. Other specialist equipment includes hoists and a sit in weighing chair. Both the dining and lounge areas were clean and tidy, but the furnishings and carpets were aged and showed signs of wear and tear. We were given an improvement plan which identified schedules of refurbishment and maintenance. This included a new carpet in the lounge with a scheduled target date of October 2009, and new chairs and tables for all communal areas in this wing, again with a scheduled target date of October 2009. The layout of the lounge area was institutional in that all chairs were lined up against the walls and gave people little opportunity to sit in groups and interact with each other. The Annual Quality Assurance Assessment (AQAA) identified this as an area of improvement. Overall the home was clean smelling, with the exception of the area around the main entrance. On the day of our visit arrangements had been made for the carpet to be cleaned and this was taking place prior to us leaving the home. There are domestic staff who have a cleaning schedule for the home and on the day of our visit we observed them carrying out their duties. The improvement plan identifies areas of the environment which have already been addressed and this includes the redecoration of some of the bedrooms and the Cooksditch House Nursing and Residential Home DS0000023399.V377726.R01.S.doc Version 5.3 Page 21 replacement of some bedroom carpets. The laundry area has been redecorated and redeveloped to provide a flow of dirty and clean laundry with a separate drying room. Further refurbishment plans include the replacement of vanity units in the upstairs bedrooms, approved wood effect non slip vinyl flooring in parts of the home, the creation of a new doorway for people to access the patio area and the completion of the refurbishment of the main building. Scheduled target dates are set between October and December 2009. In June of this year the home underwent a full infection control audit by the Health Protection Agency and received 92 . This will be re-evaluated once the main building is re-opened. Cooksditch House Nursing and Residential Home DS0000023399.V377726.R01.S.doc Version 5.3 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels meet the current occupancy levels of the home, deployment of staff needs to be monitored. People benefit from being cared for by staff that have a good understanding of their needs, however further up to date training will support staff. People are protected by the homes effective recruitment procedure although more could be done to ensure that staff receive appropriate induction into the home. EVIDENCE: Currently the staffing level is structured with a nurse and five carers on duty in the morning, a nurse and four carers in the afternoon and a nurse and 2 carers on duty overnight. The registered manager is also on duty during the day and is available to give additional support. We viewed the rotas for a four week period, and saw that they showed this amount of staff. Observations at our visit showed, however, there were times when the deployment of staff meant that there were areas of the home left unattended as staff were busy elsewhere. For example at one point we looked for a member of staff on the ground floor and could not find anybody for nearly ten minutes. The only visible member of staff was a domestic assistant who was cleaning the dining area. We looked into this and found that two members of staff were assisting someone in their room and the Cooksditch House Nursing and Residential Home DS0000023399.V377726.R01.S.doc Version 5.3 Page 23 remainder of staff were either upstairs or in a meeting. This meant that there were no available staff to attend to someone should they need any assistance. We spoke to the registered manager who said that this is not usual practice and we established that there had been a break down in communication at this point. The registered manager needs to ensure that staff are deployed so that people can be confident that there is someone available should they need assistance. The use of agency staff has been reduced and where agency needs to be used the home aims to ensure that they use a regular staff base. There is also a profile file for temporary agency staff. There is additional ancillary staff including the cook, kitchen assistants, domestic staff, a part time activities co-ordinator and maintenance assistance. The home has also employed a part time administrator who assists in the office and answers the phone. Of the nineteen care staff employed at the time of our visit only six had completed a National Vocational Qualification (NVQ) in care at level two or above. However a further nine had enrolled on an NVQ programme which will significantly increase the percentage of staff who have benefited from this and will meet the current legislative guidelines. We looked at training for staff and spoke to members of staff about their training opportunities. Records seen and discussion with staff showed and that in general a range of training was provided, including first aid, moving and handling, infection control, medication and adult protection. However more need to be done to ensure that training is consistently provided as there were gaps in adult protection, movement and handling and food hygiene training. The home has trained trainers in some of these areas and it is the registered provider’s responsibility to ensure that staff are in receipt of up to date training in the mandatory areas. Some staff have benefited from additional training in specialist areas such as continence care, swallow reflex, the mental capacity act and deprivation of liberty safeguards. Although the home is not registered to admit people with a diagnosis of dementia, as peoples conditions deteriorate people display systems of confusion and levels of dementia. Training has been provided for staff in this area. Staff records seen showed that the home had robust recruitment practices in place. A sample of files seen included application forms employment history, medical history, at least 2 written references and CRB’s and POVA checks. Discussion with the most recently employed staff member showed that she felt supported in her role and worked along side senior staff at all times as part of her induction. Although this is good practice records showed that she had not received any formal supervision during this short period and told the inspector that she had not been introduced to the homes policies and procedures. A requirement has been made that the home should review its induction procedures in this regard. There has been a significant change in the staffing levels and staff group since our last key inspection in September 2008. The staff have been through a period of change but we saw that staff moral was high. We spoke to several members of staff and comments included, ‘I feel well supported by the management of the home’ and ‘I have seen improvements in running of the home in the last few months’. People living in the home and visiting relatives all reported that staff were polite and caring. Cooksditch House Nursing and Residential Home DS0000023399.V377726.R01.S.doc Version 5.3 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33 35, 36 and 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users benefit from living in a home where the manager is competent, enthusiastic and very experienced with the care of older people and has a clear vision for the home. EVIDENCE: Since our last key inspection in September 2008, the manager has registered with us (the Commission). She is a registered nurse and holds a current registration with the NMC. She has worked in health and social care for over twenty five years and is experienced and qualified. She undertakes periodic training and is a trained trainer in movement and handling and adult protection. She is currently enrolling on the Learning and Development course for managers. Cooksditch House Nursing and Residential Home DS0000023399.V377726.R01.S.doc Version 5.3 Page 25 At interview for registration with us, she was able to demonstrate that she had a clear understanding and knowledge of the needs of older people. At our visit we saw that she was managing the home in an open and transparent manner and was working with service users, their relatives, staff and appropriate authorities to promote positive outcomes for people living in the home. On the day of our visit a relatives meeting has been arranged and we had the opportunity to speak with three relatives. They told us that they had the opportunity attend regular meetings in the home and were kept fully informed of any changes. Staff we spoke to said that they felt well supported by the registered manager and also benefited from regular meetings which enabled them to put forward their views. People living in the home said that the registered manager was approachable. The Annual Quality Assurance Assessment (AQAA) stated that regular surveys are sent out to service users and their families to monitor all aspects of care and living at the home. We did not look at the results as part of our visit, but information from service users and their relatives indicated that they any comments they made were listened to and acted upon. The registered manager has introduced an auditing system to monitor care delivery including nursing observations, weight monitoring and infection control procedures. Staff are responsible for providing the registered manager with the information and she uses the information to address any identified issues. Accidents and incidents are monitored more closely and a new incident reporting system has been recently introduced to staff and these are regularly audited to monitor patterns and look at preventative measures. Staff and new staff have training and regular supervision as part of their induction. Although records showed that some staff had regular supervision, several staff spoken to on the day of the inspection stated that they had not received supervision. They did say that day to day support from the management team was good. The manager confirmed that this is an area that she is developing at the moment and plans are in place to have an effective supervision structure for all staff. The Annual Quality Assurance Assessment (AQAA) identified that all appropriate health and safety checks have been completed. A visit by the Health Protection Environment Agency in June 2009 identified an improvement in infection control procedures with a result of 92 and a visit by the Environmental Health Officer in December 2008 did not identify any issues within the kitchen. Cooksditch House Nursing and Residential Home DS0000023399.V377726.R01.S.doc Version 5.3 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 X 3 Cooksditch House Nursing and Residential Home DS0000023399.V377726.R01.S.doc Version 5.3 Page 27 Are there any outstanding requirements from the last inspection? No 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 OP14 Regulation 14 Requirement The registered person shall ensure that the assessments of service users needs are kept under review. In that people are fully assessed in relation to Mental Capacity Act and Deprivation of Liberty. The registered person shall ensure that the persons employed by the care home receive training included structured induction training. Timescale for action 31/01/10 2 OP30 18 31/01/10 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 2 3 Refer to Standard OP27 OP22 OP36 Good Practice Recommendations It is recommended that the deployment of staff is kept under review so that there are appropriate numbers of staff in all parts of the building. It is recommended that the home continues with their environmental improvement plan. It is recommended that supervision arrangements continue to be developed. DS0000023399.V377726.R01.S.doc Version 5.3 Page 28 Cooksditch House Nursing and Residential Home Care Quality Commission Care Quality Commission Southeast Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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