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Care Home: Cornwallis

  • Trewidden Road St Ives Cornwall TR26 2BX
  • Tel: 01736796856
  • Fax: 01736797143

Cornwallis Nursing Home is a detached property located above the town of St Ives, Cornwall. It is a three-storey dwelling and is situated at the top of a hill. The home offers nursing care for up to fifty-one elderly residents with a dementia or mental health problem. Residents` accommodation is spread over three floors. Private bedrooms are shared or single, with bedrooms on the first floor having en suite provision. There are two communal lounge / dining areas, plus a conservatory, which has sea views. All rooms have call bells and assisted bathing facilities are provided. The garden area is accessible to residents. There are opportunities for socialising and visitors are openly encouraged. Information about the home is available in the form of a residents` guide, which can be 02009 supplied to enquirers on request. A copy of most recent inspection report is available in the home. Fees range from 530 to 750 pounds per week according to the operations director, who supplied this information during this inspection. Additional charges are made in respect of private healthcare provision, hairdressing and personal items such as newspapers, confectionary and toiletries.

  • Latitude: 50.208999633789
    Longitude: -5.4829998016357
  • Manager: Manager post vacant
  • Price p/w: £640
  • UK
  • Total Capacity: 51
  • Type: Care home with nursing
  • Provider: Cornwallis Care Services Limited
  • Ownership: Private
  • Care Home ID: 5003
Residents Needs:
Dementia, mental health, excluding learning disability or dementia

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for Cornwallis.

Key inspection report Care homes for older people Name: Address: Cornwallis Trewidden Road St Ives Cornwall TR26 2BX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Diana Penrose     Date: 1 6 0 4 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Cornwallis Trewidden Road St Ives Cornwall TR26 2BX 01736796856 01736797143 cornwalliscare@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Cornwallis Care Services Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 51 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Cornwallis Nursing Home is a detached property located above the town of St Ives, Cornwall. It is a three-storey dwelling and is situated at the top of a hill. The home offers nursing care for up to fifty-one elderly residents with a dementia or mental health problem. Residents accommodation is spread over three floors. Private bedrooms are shared or single, with bedrooms on the first floor having en suite provision. There are two communal lounge / dining areas, plus a conservatory, which has sea views. All rooms have call bells and assisted bathing facilities are provided. The garden area is accessible to residents. There are opportunities for socialising and visitors are openly encouraged. Information about the home is available in the form of a residents guide, which can be Care Homes for Older People Page 4 of 30 Over 65 51 51 0 0 2 2 1 0 2 0 0 9 Brief description of the care home supplied to enquirers on request. A copy of most recent inspection report is available in the home. Fees range from 530 to 750 pounds per week according to the operations director, who supplied this information during this inspection. Additional charges are made in respect of private healthcare provision, hairdressing and personal items such as newspapers, confectionary and toiletries. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Two Regulatory Inspectors visited Cornwallis Nursing Home on 16 April 2010 and spent six hours at the home. This was a key inspection and an unannounced visit. The focus was on ensuring that residents placements in the home result in good outcomes for them. All of the key standards were inspected. On the day of inspection twenty seven people were living in the home, one of these was receiving respite care. The methods used to undertake the inspection were to meet with the manager, staff and residents to gain their views and information on the services offered by the home. Records, policies and procedures were examined and the inspectors toured the building. Surveys from the Care Quality Commission were only received a week prior to this inspection so only two had been received by the inspectors. This report summarises the findings of this key inspection. The management of this home are aware of the areas that need to be improved. Historically there have been improvements but they have not been consistently Care Homes for Older People Page 6 of 30 maintained. There is a new management team in place now and the operations director intends to register with the CQC to become the registered manager. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? A management team are in place that staff feel supported by. A second activities coordinator has been employed on a full time basis. Activities and entertainment for people using the service have increased and it was evident that people were enjoying themselves. Staff were getting involved in activities and interacting much more with residents. More rooms have been refurbished and the bathing facilities have improved immensely with the provision of a new assisted bath and two wet room showers. There are plans in place for the refurbishment of the whole home. The statement of purpose has been reviewed and updated. The keys to the medicines trolleys are held with the nurse in charge. A copy of the guidelines for the use of medicines in social care is available for staff to refer to. There are more choices on the menu and records are kept of the food residents eat each day. Care Homes for Older People Page 8 of 30 The adult protection policy and the policy for managing residents money have been updated. Appropriate recruitment checks are undertaken prior to staff being employed. The Skills for Care standards have been introduced for new staff. Statutory training for staff has been kept up to date and training relevant to employees individual roles has commenced. Health and safety issues have been addressed and service and equipment checks are up to date. What they could do better: 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. Care Homes for Older People Page 9 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a suitable statement of purpose that allows prospective service users to make an informed choice about the home. Not all admissions to the home are assessed to determine that the home can meet their needs. Evidence: We were shown the statement of purpose which was suitable. Some adjustments were discussed with the management team, for example including CQC with the correct contact details and recording that service users can give notice as well as the home. We were told there had been no new admissions to the home since the last inspection, however there was one person that had recently been admitted for respite care. We inspected her care file and noted that she had received periods of respite care at the home since December 2008 and was re-admitted at the beginning of April 2010. We found that there was no completed assessment form or updated admission sheet in respect of her recent admission to the home. We saw a sheet that covered her care Care Homes for Older People Page 11 of 30 Evidence: needs for a previous admission, this was in the form of a list but there was no review seen. Risk assessment forms were seen but had not been completed. There were no assessments from external sources but a referral form was seen dated 2008. A contract of care was also seen dated 2008. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health care needs of people using the service are met with the support of external professionals however care plans do not consistently direct and inform care staff of the action they must take to meet residents specific care needs. There is a suitable system in place for dealing medicines in the home that ensures their safety. The privacy and dignity of residents is respected. Evidence: We examined two care files, one for a person recently re-admitted for respite care and one for a person who we were told was the frailest resident accommodated. We saw that one file did not contain a care plan; there was a list of needs dated January 2009 but no goals and no direction for staff. The risk assessment forms in that file had not been completed. We noted that the most recent daily recording for that person was three days prior to this inspection but it was informative. The other file contained a care plan in the same format as those seen at the last inspection. The care plan was based on the activities of daily living. We saw a plan for wound care with other supporting documents including body maps. However we did Care Homes for Older People Page 13 of 30 Evidence: not see any specific care plan for pressure area care; there was information written in March 2010 regarding turning her two hourly during the day. We saw that the care plans had been reviewed on the evaluation sheets provided but any changes in care had not been updated into the care plans themselves. The care plans were the same as at the last inspection and lacked detail to fully inform and direct staff in the care to be provided. Words such as encourage and monitor were used, for instance, with no explanation on how this should be done for the individual resident. The word regular was used rather than a specific timescale. We saw that one plan still stated several times that the person was unable to communicate but there was no information on how staff should communicate with this person verbally or otherwise. The activities co-ordinator explained to us how she communicated with this person. One of the plans we saw stated that the person was weighed each week but on talking to staff this was clearly not so. Although bed rails were in use and a consent form had been signed some time ago we did not see a risk assessment for their use. We were told that moving and handling care plans had not yet been developed; some information was provided in the mobility care plans. We saw relevant risk assessments in one care file but the scores, indicating the level of care, were not referred to in the care plans. Daily records were seen and the content was generally good although the comments were mainly about tasks undertaken rather than including social and emotional issues. Some entries did not give any detail, for example, personal care given as required and close monitoring. There were records that showed that doctors and other healthcare professionals visit the home. We were told that specialist nurses visit when asked and that some staff have special interests and act as links with the Community Nurses. Equipment was seen in use for moving and handling. Pressure relieving mattresses and cushions were also seen in use around the home. We were told that one person had a pressure sore that was healing and we saw the records. We were told that the annual continence assessments had not yet been undertaken. We were also told that there had been no Mental Capacity Act assessments or deprivation of liberties authorisations. We were told that the work on the Gold Standard Framework (GSF), for end of life care, had been resumed. We saw that residents were helped to change their position and move about more during this inspection. Staff interacted very well with residents and they were friendly and kind towards the them. The medicines policy was available to staff; the operations director told us that the document was being updated and made more easy to follow. The Guidelines for the use of medicines in social care were seen. The clinical lead nurse explained the Care Homes for Older People Page 14 of 30 Evidence: medicines system to the inspector. A monitored dose system was in use. The medicine administration and disposal records we saw were satisfactory. We noted that food supplement drinks had been signed on one chart as given to the resident but there was no record on the food/fluid chart maintained for that person. There was a photograph of the resident with their medicine records for identification purposes. We saw that most of the hand written orders on the medicine charts were witnessed with two signatures recorded. The storage of medicines was appropriate and the medicines fridge temperature was monitored daily; it was maintained within safe limits. A report written by the pharmacist and dated 12 January 2010 was seen and we were told that the issues identified had been addressed. We saw medicines being administered appropriately. We saw staff knocking on doors prior to entering rooms. We were told that when residents were not in their rooms the doors were locked; we saw that some doors did not have a lock fitted. We were told that none of the residents had a key to their room but we did not see any risk assessments in respect of key holding. Bathroom doors were locked but were unlocked on our request so that residents could access the toilets. Screens were seen in the shared rooms. We saw notices on the walls of some bathrooms giving information to staff; this sort of information should be held in a drawer or cupboard for staff to access and not be displayed on the walls of their home. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Two activities co-ordinators are employed and there has been a significant improvement to ensure that people using the service have opportunities for leisure and recreational activities according to their needs and capacities. People using the service benefit from a nutritional diet, further choices have been included on the menu to ensure their personal preferences are met. Evidence: A new full time activities co-ordinator had recently been employed and worked with the part time co-ordinator. She was very highly qualified for the role. We saw a great deal of activity going on during this inspection and residents were clearly enjoying themselves. Care staff were participating with activities throughout the day, playing ball, looking at books and chatting with residents, for example. During the afternoon some residents went into the garden with staff and various activities were taking place, music was being played and some people were dancing. The activities co-ordinator told us about her role and showed us some documentation. An annual year planner was seen, outside entertainers, choirs, school children and various religious ministers were included in the plans. A monthly calendar of events was on display and included pictures, photographs and residents birthdays. We were Care Homes for Older People Page 16 of 30 Evidence: shown a large number of photographs of residents taking part in activities both inside and outside of the home. We were told that some residents had been taken out on trips, for example, to The Tate Gallery and to Paradise Park. We saw posters depicting significant dates, for example Easter and British Summer Time, these had been used for orientating people to the time of year. The activities co-ordinator said she had been meeting with residents and relatives to get an understanding of peoples backgrounds interests and what their hobbies used to be. We were shown individual records that were maintained for each resident. They were detailed and contained information on the persons feelings and the amount of participation and so on. Some were quite lengthy and very informative but the coordinator said they still do not capture all they need to capture. We were told a system was being developed so that care staff could record the activities they do when the co-ordinators are not around. We were told that care staff have taken more interest in activities and that residents appetites and sleeping patterns have improved. The visitors book showed that the home receives regular visitors. The front door was not locked and gave access to the office and laundry. Visitors were seen assisted by a staff member to get in and out of the door to the residents accommodation as it was secured and opened by a key pad. We saw visitors being welcomed by staff and offered a hot drink. One survey received from a relative said that visitors are made very welcome. We saw that people could bring personal possessions into the home but some bedrooms were quite bare. There were records of personal preferences in care files and food likes and dislikes were recorded in the kitchen. Breakfast was seen to go on late into the morning. There was little to show that people chose when to bath or shower but staff said this was generally once a week. Residents who were able were moving freely around the home. One survey from a relative stated that staff are very attentive to individual needs. We saw that a satisfactory menu was in place with choices available and we saw staff asking residents what they would like for lunch. The meal on offer was written on white boards in the lounges. We saw the food records that were now maintained in the kitchen and these showed that people had different things to eat, not just a set menu. There was a list in the kitchen of the residents who required liquidised or partially liquidised meals. The setting for meals in each lounge was seen to be appropriate. We observed lunch to be unhurried with assistance given positively and sensitively. There were good food stocks in the home that included fresh fruit and vegetables. We were told that cakes were homemade. We saw that refreshments were available in the Care Homes for Older People Page 17 of 30 Evidence: lounge/dining rooms all day and we were told that snacks were available day and night. We were told that snacks for those on a liquidised diet were also available including soups and puddings. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 home has suitable complaints and adult protection policies and staff have attended suitable training in respect of adult protection to ensure that people using the service are safeguarded. Evidence: We saw an appropriate complaints policy that was available to staff. A few minor changes were needed and these were fed back to the operations director. We were told there had been no complaints to the home since the last key inspection; the last one recorded in the home was in August 2006. Concerns had been raised to the Commission in early February this year. These were in respect of the attitude of the manager, who has since left, staffing levels, dietary issues, including cheap food, not enough and no choice and restraint by keeping almost all residents in one lounge. A random inspection was carried out by three inspectors the visit included dementia mapping observations and gaining the views of external professionals. The random inspection identified that staff interacted well with residents and each other and they did so in a respectful, kind and caring manner. Several areas for improvement were identified: employment and deployment of nurses and care staff, employment of a manager to be registered with the Care Quality Commission, ensuring that record keeping was completed appropriately and ensuring that residents Care Homes for Older People Page 19 of 30 Evidence: assessed as nutritionally at risk received appropriate and sufficient dietary intake. Three requirements and one recommendation were notified and have been or are being addressed; an action plan has been sent to the Commission. We saw an appropriate adult protection policy that had recently been updated. We saw the training records that show staff had received training in respect of abuse and that further training had been booked for new staff. Staff told us they had found the training useful. We saw that some staff had attended training on the Mental Capacity Act and Deprivation of Liberties, the operations director told us that others would be attending the training next week. There needs to be a risk assessment process for the use of bed rails and other forms of restraint such as recliner chairs. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was clean and warm, there was an unpleasant odour in one lounge which was being investigated, further redecoration and refurbishment has been done and an improvement plan is in place to make the home a pleasant, homely place to live in. The bathing facilities have been addressed and there are now appropriate bathing and toilet facilities for people who are frail and disabled. Evidence: We toured the building and we were shown two new wet room facilities that had been provided. These rooms were locked but they were left unlocked on our request so that residents could access the toilets. The ground floor bathroom had had a new bath installed and the room was in the process of being re decorated. We were told a new bath hoist was to arrive within days of this inspection. We were shown some unoccupied rooms that had been totally refurbished and these were a vast improvement; some double rooms had been converted into large singles. The colour schemes were brighter and pictures had been incorporated. The operations director told us that these rooms were of the standard to be provided throughout the home. We saw that picture frames had been placed on the doors of residents rooms and some contained pictures and photographs for people to identify their own room. We reminded the management team and activities co-ordinator to be mindful of confidentiality and to gain consent for photographs to be used. Care Homes for Older People Page 21 of 30 Evidence: We noted an overbearing musty smell in the garden lounge and we were told that the cause had not been identified but action had been taken to eliminate the smell by regular carpet cleaning. The operations director told us that the carpets in both lounges were to be replaced. We were told that the heating system was now in full working order and the home was warm during this inspection. We were also told that there was a programme to ensure that all radiators were covered for safety. We saw that blinds had been fitted in the conservatory which had transformed the room. We were told the room was used more often now. The garden was seen to be tidy with sturdy garden furniture provided. The wooden fence had been replaced and secured. The laundry was seen and there were no changes. We saw two sluices with a washer disinfectors, there was no hand washing facility in the upstairs sluice and we were told this would be rectified. Alcohol hand sanitising gel was provided. Hand washing facilities with liquid soap, paper towels were seen in use throughout the home. We also saw that protective gloves and aprons were in use. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staff are employed to meet the needs of the people currently using the service. Recruitment is robust, the skills for care induction programme has been introduced and training has been taking place regularly to ensure staff are knowledgeable and skilled in their roles. Evidence: The operations director told us he had reviewed the staffing levels and was confident they were suited to the needs of people using the service. He said he was always guided by the clinical lead and other nurses. The rota was seen and showed that there was one nurse on duty each day with five care staff. There was one nurse and two care staff at night. There was not a Registered Mental Nurse (RMN) on duty all of the time. The clinical lead nurse was an RMN and tended to have her office days when a Registered General Nurse (RGN) was on duty. Agency staff were employed for caring for people with one to one needs and other shifts when required. Staff told us they thought the staffing levels were good for the number of residents now accommodated (27). We did not observe staff rushing around and there seemed to be sufficient to care for people using the service. Five staff files were inspected, all were employees who commenced work between December and April; all of the documents required by inspection were included apart from photographs of the employees. Pre-employment checks were undertaken Care Homes for Older People Page 23 of 30 Evidence: appropriately. Interview records were seen in four files; the management team were reminded to ensure that gaps in employment were investigated and recorded. Induction records were seen, some were in line with the skills for care standards. We were told that e-learning was being considered as part of the induction training. We were shown a training matrix and a file containing copies of certificates for training undertaken. All training was seen to be up to date or booked. We were told that training was identified during appraisals and supervision. Training in respect of challenging behaviour and dementia had been undertaken by some staff. The Regulation 26 report for February 2010 stated that the clinical training that month included leg ulcer compression bandaging, tissue viability and wound care, end of life care, falls and osteoporosis. We were told that all bar two care staff had an NVQ qualification in care and the remaining two were on the course. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements for home have lacked stability for a significant time; the operations director intends to apply for registration with the CQC and continue to run the home with the support of a clinical lead nurse and facilities manager. Some Quality Assurance monitoring takes place but the system needs to be developed. There is a system for dealing with residents personal money that ensures their finances are protected. Health and safety is taken seriously for the protection of residents, staff and visitors to the home. Evidence: The home does not currently have a manager registered with the Care Quality Commission. However the operations director stated that he was going to apply for this post and had commenced the Leadership and Management Award. He was running the home with a clinical lead nurse and a facilities manager. The clinical lead nurse told us she networks frequently with the manager and an RGN, who work at one of the other homes in the group, and finds this very helpful. Care Homes for Older People Page 25 of 30 Evidence: Staff told us they get on well with the operations director and they spoke highly of the clinical lead nurse. One person said she felt the clinical lead nurse (she called her the manager) was supportive, she could ask for help and she would get it. Staff generally felt the atmosphere in the home was much more relaxed and settled now. The facilities manager said it was a pleasure to come to work. Quality assurance questionnaires had been distributed by the previous manager, the responses we saw were positive about the staff and the care provision. There were some concerns in respect of clothes shrinking in the laundry process and ornaments being broken and relatives not being informed. We were told these issues had been addressed. The minutes of staff and relatives meetings were seen, meetings had taken place in the last two months but those prior to this were in November 2009. Separate meetings were held with the nurses, night staff, domestic staff and activities staff. The operations director compiles reports in line with Regulation 26 and sends them to the Commission each month. We were not shown evidence of any audits undertaken. The policy for managing residents monies was updated just after this inspection and a copy sent to the Commission. It was satisfactory and directed staff in the actions they should take. We were told that no residents controlled their own money. We were told that the home held personal money for some people so that they could access cash for personal spending. Money was seen stored in the safe in separate wallets. The money for one person was checked and correct with the records. There was a transaction sheet for each person and two members of staff signed and dated the transactions. Receipts were seen for purchases and they were numbered for auditing purposes. The facilities manager said she held the safe key and would come into the home out of hours if needed. The operations director said some petty cash would be made available so that the nurse in charge had access to cash if needed for residents out of hours. We saw some valuables held in the safe and receipts were held with duplicates in the care files. We saw that the fire records were all up to date; the latest fire drill was 7th April when 18 people attended. Fire equipment training was attended by 23 people in January 2010. Servicing and equipment maintenance records were seen and up to date or booked. Statutory training for staff was also seen to be up to date or booked. The accident records showed fifteen accidents for March and five for April so far. We were told the individual record sheets and audit records for accidents were no longer in use but the operations director said he hoped to reinstate these. The accident policy refers to these records and CSCI which needs to be changed to CQC. Care Homes for Older People Page 26 of 30 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 31 8 A manager must be appointed and be registered with the CQC To run the home and to provide leadership for the staff 28/06/2010 Care Homes for Older People Page 27 of 30 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, Care Homes 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 3 14 Prospective service users needs must be thoroughly assessed prior to them moving in to the home and kept under review To ensure that the home can fully meet their individual health, social and emotional care needs. 31/05/2010 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 7 Care plans should be further developed to ensure they include all information about the persons care needs and they fully inform and direct staff on the individual care provision. The daily records should encompass peoples social and emotional needs and reactions, not just detail tasks that have been undertaken by staff. The registered persons need to ensure that the improvement plan they have developed for the premises is adhered to, this will then provide a safe , comfortable,homely environment for people using the Page 28 of 30 2 7 3 19 Care Homes for Older People 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 service. 4 29 Detailed interview records should be maintained that include the discussion of gaps in employment and other important issues that arise this will help to protect people using the service. Care Homes for Older People Page 29 of 30 Helpline: 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). 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. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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