Care Home: Cow Lees Nursing Home

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What the care home does well People who are considering moving into the home have their care needs assessed so that they can be sure the home can meet their needs. Reviews are regularly undertaken with people, representatives and professionals and changes are agreed. Best interest decisions are appropriately made when people are unable to make decisions for themselves. Independence is encouraged so that people retain their abilities. Cow Lees Nursing Home DS0000004391.V377060.R01.S.doc Version 5.2 People can have confidence that a concern or complaint will be acted upon to their satisfaction. People find the management team approachable and staff told us that managers are supportive. Continuous learning and development is evident. Staffing meets people`s needs including one to one support to help people keep in touch with relatives. We observed good interaction between staff and the people who live at the home. Staff were seen to respond to requests for assistance in a friendly but respectful manner. There is an experienced management team in the home and they are supported by the service provider who visits regularly. Records are up to date and secure to maintain confidentiality. The comments received in the surveys from people using the service, relatives and staff, and on the day with regards to what the service does well, included: • • • • • • • • • • “All aspects of care is excellent, could not wish for a better home for my relative.” “They provide love, care and attention to all the residents,” “I am satisfied with everything.” “Carers are dedicated and very obliging so I have no complaints.” “All staff and management are very professional and friendly and nothing is too much trouble.” “It is comforting to know that my relative is in the safe care of Cow Lees.” "I feel the staff at the home are extremely loyal and hardworking, a real asset to the home.” “Management are always on hand to listen and help with any questions or queries staff may have.” “Training here is excellent and I think all staff enjoy training sessions.” “I personally enjoy every day, working in an environment that is happy, comfortable and with lovely residents and staff.” What has improved since the last inspection? Cow Lees Nursing HomeDS0000004391.V377060.R01.S.docVersion 5.2The dining room has been refurbished since our last inspection visit. Lunch is a pleasant relaxing experience for people. They are assisted to eat in a sensitive manner in comfortable surroundings. The home’s policies and procedures for responding to suspicion or allegation of abuse has been reviewed and updated to reflect local social services guidelines. This helps ensure people are safeguarded from abuse. Hoists in the home are serviced at regular intervals ensuring people are protected from the risk of injury. What the care home could do better: The information received from the people using the service, their relatives and our findings during the site visit demonstrated that Cow Lees Nursing Home continues to improve the quality of care and services provided. There were no significant areas of risk identified during the inspection of the service. We have made one requirement as a result of this inspection visit. Improvements to medicine management would further ensure the health and well being of people living in the home. Key inspection report CARE HOMES FOR OLDER PEOPLE Cow Lees Nursing Home Astley Lane Bedworth Warwickshire CV12 0NF Lead Inspector Patricia Flanaghan Key Unannounced Inspection 4th August 2009 09:00 DS0000004391.V377060.R01.S.do c Version 5.2 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. Cow Lees Nursing Home DS0000004391.V377060.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 Cow Lees Nursing Home DS0000004391.V377060.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cow Lees Nursing Home Address Astley Lane Bedworth Warwickshire CV12 0NF 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) 02476 313794 02476 316750 cowleescarehome@yahoo.co.uk Mr John O`Sullivan Mrs Carole O`Sullivan Margaret Bailey Care Home 52 Category(ies) of Dementia (52) registration, with number of places Cow Lees Nursing Home DS0000004391.V377060.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care with nursing and accommodation for service users for both sexes whose primary care needs on admission to the home are within the following category:dementia, DE, 52. The maximum number of service users to be accommodated is 52. 2. Date of last inspection 24th September 2008 Brief Description of the Service: Cow Lees Nursing Home is registered to provide accommodation to 52 older people with dementia nursing care needs. The home is situated approximately 2 miles from Bedworth town centre in a rural location and offers panoramic views over the countryside. The location of the home does not offer easy access to local shops, local transport services and other community amenities. The accommodation is provided in two main care areas, Cow Lees House and Astley House, a purpose built addition with single en-suite accommodation of 24 beds. The buildings are not structurally connected. Accommodation in Cow Lees House is provided in mainly shared rooms. Off road parking is provided at the front of the home in an allocated space. Access to all care areas is via passenger lift/stairs. A number of rooms in Cow Lees have limited access; residents occupying these must be able to negotiate small flights of stairs. Gardens areas are easily accessible to all residents; garden areas are mature and well maintained. Information about the home is available in the home’s ‘Statement of Purpose’ and the ‘Service Users Guide’. Cow Lees Nursing Home DS0000004391.V377060.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. The inspection of the service was unannounced and took place on 4 August 2009 over a period of approximately nine hours. A pharmacist inspector undertook an inspection of medication management in the home on the same day. A range of evidence was used to make judgements about this service to include discussions with people using the service, visitors, the registered manager, deputy and staff. We also examined a number of records including care records of people living at the home, staff training, staff recruitment and health and safety records. Prior to our visit the home completed their Annual Quality Assurance Assessment (AQAA). The AQAA provides information about what has improved and is planned for the future, and current information about the running of the home. Information from this and from other sources was also used when forming judgments on the quality of the service. The home sends us notifications, and we receive reports from other sources, including surveys sent to people, relatives and staff. Three people who live in the home were case tracked this involves establishing a person’s experience of living in the care home by meeting them, discussing their care with staff, looking at care files and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. Information to produce this report was gathered from the findings on the day and also by review of information received by CQC prior to the inspection date. A quality rating is provided throughout the report based on each outcome area for the people who use the service. What the service does well: People who are considering moving into the home have their care needs assessed so that they can be sure the home can meet their needs. Reviews are regularly undertaken with people, representatives and professionals and changes are agreed. Best interest decisions are appropriately made when people are unable to make decisions for themselves. Independence is encouraged so that people retain their abilities. Cow Lees Nursing Home DS0000004391.V377060.R01.S.doc Version 5.2 Page 6 People can have confidence that a concern or complaint will be acted upon to their satisfaction. People find the management team approachable and staff told us that managers are supportive. Continuous learning and development is evident. Staffing meets peoples needs including one to one support to help people keep in touch with relatives. We observed good interaction between staff and the people who live at the home. Staff were seen to respond to requests for assistance in a friendly but respectful manner. There is an experienced management team in the home and they are supported by the service provider who visits regularly. Records are up to date and secure to maintain confidentiality. The comments received in the surveys from people using the service, relatives and staff, and on the day with regards to what the service does well, included: • • • • • • • • • • “All aspects of care is excellent, could not wish for a better home for my relative.” “They provide love, care and attention to all the residents,” “I am satisfied with everything.” “Carers are dedicated and very obliging so I have no complaints.” “All staff and management are very professional and friendly and nothing is too much trouble.” “It is comforting to know that my relative is in the safe care of Cow Lees.” I feel the staff at the home are extremely loyal and hardworking, a real asset to the home.” “Management are always on hand to listen and help with any questions or queries staff may have.” “Training here is excellent and I think all staff enjoy training sessions.” “I personally enjoy every day, working in an environment that is happy, comfortable and with lovely residents and staff.” What has improved since the last inspection? Cow Lees Nursing Home DS0000004391.V377060.R01.S.doc Version 5.2 Page 7 The dining room has been refurbished since our last inspection visit. Lunch is a pleasant relaxing experience for people. They are assisted to eat in a sensitive manner in comfortable surroundings. The home’s policies and procedures for responding to suspicion or allegation of abuse has been reviewed and updated to reflect local social services guidelines. This helps ensure people are safeguarded from abuse. Hoists in the home are serviced at regular intervals ensuring people are protected from the risk of injury. 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. Cow Lees Nursing Home DS0000004391.V377060.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cow Lees Nursing Home DS0000004391.V377060.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3. Quality in this outcome area is good. People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care files of two residents admitted to the home since the last key inspection were examined to assess the pre admission assessment process. The manager told us that either her deputy or herself, with another member of nursing staff, carry out the assessments in a persons own home, other care homes when peoples needs change, or while they are in hospital. One of the Cow Lees Nursing Home DS0000004391.V377060.R01.S.doc Version 5.2 Page 10 care plans examined showed us that the person had had their pre admission assessment carried out in a residential care home. All files showed details of an assessment of each persons needs. The home has a standard pre admission assessment form which covers activities of daily life, which include personal care, eating and drinking, continence, socialising, communication and spirituality. There was evidence on files to show that information had been obtained from health and social care professionals before people moved into the home. A visitor told us on the day of the visit that both the manager and deputy had been to assess their relative at another nursing home. They said management had asked a lot of questions about the person’s care needs and confirmed they had visited the home to have a look around. The visitor commented, “My relative has had nothing but kindness and excellent care since they moved here. We (the family) are always made welcome and I can’t praise staff enough.” Cow Lees Nursing Home DS0000004391.V377060.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 People using the service experience good quality outcomes in this area. Staff have the information they need and have a clear understanding of how to offer care to each person, which ensures peoples health and personal care needs are met in a way that they prefer. Whilst the majority of medicines had been administered as prescribed further work is required to ensure that all the medicines are administered at all times. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We assessed how peoples health and personal care needs are met. The information we gathered from the self-assessment tool (AQAA) completed by the Responsible Individual told us that the home “use a person centered approach to care planning. Care plans contain risk assessments and are reviewed at least once a month.” Cow Lees Nursing Home DS0000004391.V377060.R01.S.doc Version 5.2 Page 12 We looked at the care plans for the three people who were followed through the case tracking process. Each person had a care plan, which identified the person’s care needs based on their activities of daily living. The plans of care are based on the initial pre-admission assessment of people’s needs and a further admission assessment is carried out when they are admitted to the home. These include for example personal care, eating and drinking, spiritual, socialising, mobility and health promotion. Risk assessment tools available and completed for these people included identifying the level of risk for people in relation to falls, nutrition, mobility and moving and handling. Risk assessments had also been completed related to the risk of people developing skin wounds due to pressure area damage. When the outcome of the assessment identifies an increased risk, action is implemented to minimise the risk. This should promote peoples well being. For example, one person was identified as having a high risk of falls. A care plan was available to support their mobility including action to be taken to minimise the risk of falls. There were good details about the type of moving and handling equipment that people needed to use so that the person and staff were safe. Another person identified as having a moderate risk of developing pressure sores had a care plan to minimise the risk. This included the use of a pressure relieving mattress which we observed in use and regular repositioning which was recorded on a turn chart Another person who has diabetes controlled with insulin had a care plan for monitoring their condition and records showing their blood sugar levels were monitored regularly. There was evidence that people are seen by external health care professionals such as the GP, dentist, optician and people are assisted to attend hospital appointments. This ensures that people receive specialist advice and that their care needs are met. People were well presented and were supported by staff to choose clothing that reflected individual choices. Staff were observed to treat people with respect and maintain their dignity. We spoke with three nurses and four care staff. They were familiar with peoples needs and abilities, and knew what care they needed. We saw during this inspection that people were spoken to appropriately and in their preferred term of address. We saw staff spending time with people, when people were upset or distressed they offered them comfort. We also saw staff have a good rapport with the people who live here and there were some very positive interactions. Cow Lees Nursing Home DS0000004391.V377060.R01.S.doc Version 5.2 Page 13 The pharmacist inspection took place at the same time as the key inspection. Eight peoples medication, Medicine Administration Record (MAR) charts and care plans were looked at. The medicine management was assessed in all three units within the home. Two nurses were spoken with and all feedback was given to the manager and deputy manager. Three separate rooms were used to store the medication on each unit. The air conditioning did not maintain the temperature below 25C in the main medication room. This was switched back on during the inspection and the temperature was reduced. The medicine refrigerator temperature was above 8C, so failed to store these medicines correctly. It did require defrosting. All the prescriptions are seen prior to dispensing and copies of most of these were seen. These should be used to check the medicines and MAR charts received into the home for accuracy. The majority of medicines were dispensed in a Monitored dosage system whereby each tablet is dispensed in a blister pack for each day. Audits indicated that these had been administered as prescribed. Errors were seen though for the medicines administered from traditional boxes and bottles. Medicines had been recorded as administered when they had not been and some medicines were unaccounted for. Nursing staff were unable to offer any explanation as to why most of these discrepancies were found. Evidence of covert administration was seen, where the medicines were crushed and put in food. The medicines were put on top of a spoon of food to aid administration and not mixed up in food. Whilst a consent form had been signed by two nurses and the next of kin, the manager had failed to obtain further consent from the wider clinical multidisciplinary team. We, the commission, were assured that verbal evidence was given by the doctor and he was aware of the way the medicines were given. It was advised that further written consent was obtained. Most GP visits and communications were recorded but it was not possible in some instances to see why a dose of a medicine had been increased for example. One medicine had been prescribed two months ago and still available to administer but there was no record of it on the MAR chart. All medicine on the premises must have supporting documentation or be destroyed if no longer required. The care plans did not record all the medical conditions of the people. It was not possible to identify why some medicines had been prescribed. The deputy manager said it was quite difficult in some instances to obtain this information from the doctor. The nurses often understood why some medicines had been prescribed but this information was not readily available to read in the care plans. New or agency nurses would struggle to know exactly what clinical needs some of the people had. Cow Lees Nursing Home DS0000004391.V377060.R01.S.doc Version 5.2 Page 14 One of the nurses spoken with had a very good understanding of the medical conditions of the people he looked after and also what the medicines were for. The other nurse spoken with lacked such knowledge and did not know what the medicines used to treat non psychiatric conditions were for. The managers have installed a quality assurance system to assess individual staff practice in the administration and recording of medicines. This had failed to identify the issues found at this inspection and needs to be reviewed to ensure that the nursing staff administer all the medicines as prescribed at all times. All controlled drug balances were correct and records reflected practice. One entry by a nurse on duty at night failed to record any witness signature as required by current regulations. The administration of all controlled drugs must be witnessed and signed as such. Cow Lees Nursing Home DS0000004391.V377060.R01.S.doc Version 5.2 Page 15 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): Standards 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. People have a choice of activities so that they experience a meaningful lifestyle. There is a choice of meals to meet people’s dietary needs or personal preferences. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The service told us in the AQAA that an area for improvement was providing more activities for people. The home has recently developed an activity team of four people who will focus on organising a range of home based and community activities to meet people’s individual needs. The home has visiting entertainers and a fete took place recently. Four people recently had a week’s holiday in rented bungalow by the sea. We chatted with one of the people who had been on holiday who told us how much they enjoyed it. We saw the holiday photographs and it was evident that people had outings to the seaside and local places of interest. Cow Lees Nursing Home DS0000004391.V377060.R01.S.doc Version 5.2 Page 16 We spoke with one of the recently appointed activity coordinators and she explained how she had received information from the Alzheimer’s Society on providing recreational activities for people with a dementia. She was very enthusiastic about her new role and said she was looking forward to ensuring that people had appropriate stimulation throughout the day. She also told us she was helping to compile a ‘life history’ for each person. A life history record contains useful information which gives staff an insight into the person, their life, likes and dislikes. It also can be used to initiate conversations between staff and residents. The activity coordinator was aware of the importance of obtaining as much information about preferences, routines, and likes and dislikes as possible to maintain individuals preferred daily routines and provide person centred care. The home has an open visiting policy, which means that people can see their visitors as they chose and maintain relationships that are important to them. We spoke with five visitors who all said they were made welcome when they visit. Comments included: “I am always made very welcome when visiting.” “Staff can’t do enough to make me welcome. They give me a cup of tea and always ask how I am.” The manager and deputy explained to us how they had improved the dining experience for people since the last inspection visit. This ensures people have a more enjoyable eating experience and help to maintain their appetite. Plastic aprons and table coverings had been replaced with table cloths and cloth napkins. The dining rooms in both houses are large and airy. Tables were set with table cloths, napkins, glasses, condiments and cutlery. Lunch on the day of the visit was chicken casserole with mixed vegetables or pasty. People were shown a photograph of the meal to help them choose what they wanted to eat. Meals were well presented and appetising. Practice observed at lunch time showed that care staff and nurses supported people in a discreet and sensitive manner when helping them to eat and enjoy their meal. The home can cater for meals to meet dietary requirements. We saw portions on pureed meals were individually served on the plate so that people could experience the taste and texture of the foods. Drinks are available throughout the day, for example, tea, coffee and cold drinks. We briefly viewed the kitchen and saw it was clean and organised. Good stocks of food were available in the fridges, freezers and storage areas. The environmental health officer had inspected the home in May 2009 and assessed them as having good standards for food hygiene and safety in the kitchen. Cow Lees Nursing Home DS0000004391.V377060.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 People using the service experience good quality outcomes in this area. People living in the home can be confident that their concerns will be listened to and acted upon. Processes are in place to help protect the vulnerable people who use this service from harm. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has a clear complaints policy and process, which is available in the reception area and in the statement of purpose. The home keep a record of all low level concerns and complaints that people may have. A clear record of the investigation and actions taken to resolve them were documented. The manager and deputy manager both indicated that where possible minor issues are addressed quickly before they escalate. This showed that the service is pro-active in responding to concerns quickly and therefore had not received any serious complaints. The responses in the surveys received from people using the service and their relatives all indicated that they were aware of how to complaint and who to speak with if they are unhappy about the care or the provisions at the home. Cow Lees Nursing Home DS0000004391.V377060.R01.S.doc Version 5.2 Page 18 People we spoke with told us they knew what to do if they were unhappy with the service they receive and reported that they have no concerns of complaints about the home. A person who lives at the home told us, “What have I to complain about, I am very happy here.” A visiting relative said, “we have found it very easy to talk to the manager or deputy. Any little things we have raised have been sorted immediately.” The home has a copy of the local Multi Agency Guidelines and an adult protection policy and this should ensure that staff have guidelines to follow in the event of any allegations of abuse. There has been one adult protection case since our last visit, where an allegation was made about poor medication practices and staff attitudes and training. This has been investigated by the local safeguarding team and the referral has been closed with no action being taken. Discussion with staff and training records seen demonstrated staff had received training in safeguarding so that they have up to date knowledge about what they should do to keep people safe. Staff spoken to were able to give satisfactory responses to questions about how to keep people safe. The manager and the deputy manager, who are trained nurses, had received training in the Mental Capacity Act and Deprivation of Liberty Safeguarding. This act governs decision making on behalf of adults and applies when people lose mental capacity at some point in their lives or when they have had an incapacitating condition since birth. The manager told us that this training was to be rolled out to other staff so that they have the knowledge about the procedure to follow when people’s freedom may be restricted. Cow Lees Nursing Home DS0000004391.V377060.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 24 and 26 People using the service experience good quality outcomes in this area. People are provided with a homely, clean and comfortable environment in which to live that meets their individual needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Accommodation in the home is provided in two separate buildings. Cow Lees House is a converted building and Astley House is a purpose built extension. The home has an ongoing plan of maintenance and refurbishment. The two buildings are in complete contrast to each other. Cow Lees House is a much older building, providing accommodation in primarily shared rooms with only one room having en-suite facilities. The manager told us that Cow Lees Nursing Home DS0000004391.V377060.R01.S.doc Version 5.2 Page 20 refurbishment remains ongoing. The home is decorated and furnished to a satisfactory standard and was clean and tidy on the day of inspection with no unpleasant odours. In Cow Lees House there are two lounges, one called the music room, a large entrance hall where residents are also able to sit and watch the comings and goings from the home, and a large dining room. Some people choose to eat their meals in the music room, as this area is quieter. The outside courtyard between the two houses is secure so that residents can safely access and make use of this area independently. Astley House is a modern purpose built extension, providing spacious accommodation with en-suite bedrooms. There is a conservatory on the ground floor. This house is well decorated, with good quality furnishings. The home has a very attractive large landscaped garden which is well maintained. People living at the home confirmed that they frequently use the gardens in finer weather. Systems are in place for the management of dirty laundry. Protective clothing such as plastic gloves and aprons were available and arrangements are in place for the disposal of waste. Cow Lees Nursing Home DS0000004391.V377060.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 People using the service experience good quality outcomes in this area. People using the service are protected and supported by good staff recruitment andtraining that promotes their health, safety and well-being. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Some staff have worked at Cow Lees for many years and there is a low turnover. Staffing hours are kept under review and staffing appeared to match peoples needs, including at peak times such as mealtimes. The workforce is diverse, so people in the home can have choice of who helps them with personal care. In addition to care staff, there are catering and domestic staff. Each person has a key worker who takes a special interest in them. Staff pass information to each other about people and the home at each shift change, and keep records up to date so people have consistency of care and support. There are regular staff meetings that seek staff views on the running of the home. We looked at the files of three staff employed since our last inspection to make sure that pre employment checks are undertaken so that staff are checked as being suitable to work with vulnerable adults. Files were well organised and Cow Lees Nursing Home DS0000004391.V377060.R01.S.doc Version 5.2 Page 22 contained all the checks required under regulation. New staff have an induction to safe working practices, followed by a longer induction to Skills For Care standards. An ongoing training programme includes mandatory training and other opportunities through college or health so that peoples conditions and medication are understood. Just over half the staff have NVQ qualifications in care which meets the minimum standards. This training helps staff provide more effective care to people living at the home. The home continues to mentor student nurses and they work in the home as extra staff to those permanent staff on the duty rota. The deputy manager explained that training is undertaken with staff in the home all of the time so that new processes and techniques can be shared to ensure consistency in staff approaches to care. People spoken with were very positive about the staff support in the home. Comments received included: • • • “Carers are dedicated and very obliging so I have no complaints.” “All staff and management are very professional and friendly and nothing is too much trouble.” I feel the staff at the home are extremely loyal and hardworking, a real asset to the home.” Cow Lees Nursing Home DS0000004391.V377060.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the service experience good quality outcomes in this area. People have confidence in Cow Lees because it is effectively managed in the best interests of the people living and working there. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The registered manager is suitably qualified to manage the care home and has a number of years experience in the care sector. The staff receive clear guidance on how to perform their role and there is a clear understanding from staff of what is expected of them. This ensures that people living at the home receive consistent care and support of a good standard. Cow Lees Nursing Home DS0000004391.V377060.R01.S.doc Version 5.2 Page 24 The comments received in the surveys from the people using the service, relatives, and the staff were positive about management of the home. Our observations and discussion the people using the service and the visiting relatives also indicated that they were satisfied with the management of the home. Comments received include: • “Management are always on hand to listen and help with any questions or queries staff may have.” Staff spoken with all confirmed they have clarity in their roles and responsibilities, take instructions from the nurse in charge, the manager and deputy manager, and work as a team. Staff confirmed they have regular staff meetings, training and supervision to ensure they receive the right information about meeting peoples needs and changes in best practice. Staff spoken with confirmed they receive timely supervisions to discuss work issues and training needs and records seen confirmed this. We noted that there is a quality assurance system in place whereby views are gathered through surveys given to people using the service, relatives and health and social care professionals involved with the home. We saw a considerable number of thank you cards and letters in the home, which suggests satisfaction with the service provided. The home does not hold personal monies for safekeeping for any of the people living in the home. Bills are produced for additional charges for chiropody and hairdressing and sent to the person appointed to manage the person’s finances. This is usually a relative, solicitor or the Advocacy services. A review of the health and safety records in the home was undertaken to confirm health and safety checks are being undertaken and equipment in the home is safe. All checks required such as of the fire safety systems, lifting equipment and electricity are in place. People are protected through regular maintenance of systems and equipment and records to show this are well organised. Cow Lees Nursing Home DS0000004391.V377060.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Cow Lees Nursing Home DS0000004391.V377060.R01.S.doc Version 5.2 Page 26 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 OP9 Regulation 13(2) Requirement The medicine chart must be referred to before the preparation of the service users medicines and be signed directly after the transaction and accurately record what has occurred. All controlled drug administration must be witnessed. The right medicine must be administered to the right service user at the right time and at the right dose as prescribed and records must reflect practice Timescale for action 30/09/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations It is recommended that all medicines are stored in compliance with their product licences and conditions in DS0000004391.V377060.R01.S.doc Version 5.2 Page 27 Cow Lees Nursing Home the medication rooms and refrigerator are checked daily to ensure this occurs. 2. OP9 It is advised that the quality assurance system is revised to ensure that all nurses are individually assessed on a regular basis and further training is obtained for staff that require more information on the therapeutic indications of the medicines they handle. Cow Lees Nursing Home DS0000004391.V377060.R01.S.doc Version 5.2 Page 28 Care Quality Commission Care Quality Commission West Midlands 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. 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