Care Home: Cromwell House

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What the care home does well Cromwell House offered its` residents a good standard of accommodation in pleasant surroundings at the centre of the city of Norwich. The care home was clean and tidy and well maintained with accessible, attractive gardens. The atmosphere within the care home was relaxed and friendly and residents evidently enjoyed socialising with one another and taking part in the activities designed to meet their needs. The care home emphasised its` intention to meet the spiritual needs of people living there and this was made evident in the Service User Guide and by observance of regular religious practices. This was particularly important to many residents although it was stressed that people did not have to follow the Methodist faith to reside or work at Cromwell House. Residents described members of the staff team as kind and helpful, saying they felt everyone "did their best to make you feel at home here". Members of staff were well trained and a high proportion of the team were accredited to NVQ Level2. Some carers were progressing to Level 3. What has improved since the last inspection? What the care home could do better: As noted above, while the new care plan system was very detailed and comprehensive in the way it addressed the needs of residents, the format was complex, including multiple daily records that staff found confusing. This system could be simplified. While staffing levels were sufficient given that the care home was not full to capacity, once it became so, numbers might need to be increased. The manager would need to take great care in this area to ensure sufficient staff were available at all times to meet the needs of residents. There was lack of clarity as to the intentions of the operators of the service regarding how the care home would be managed in the continued absence of the registered manager. The providers needed to be more observant of the Care Standards Act 2000 Regulations and report matters to CSCI as required (Regulations 26 and 38 had not been correctly acted upon) CARE HOMES FOR OLDER PEOPLE Cromwell House Cecil Road Norwich Norfolk NR1 2QJ Lead Inspector Mrs Ginette Amis Unannounced Inspection 26th February 2008 10:20 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cromwell House DS0000027269.V360238.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cromwell House DS0000027269.V360238.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cromwell House Address Cecil Road Norwich Norfolk NR1 2QJ 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) 01603 625961 01603 660581 home.nor@mha.org.uk home.fxg@mha.org.uk Methodist Homes for the Aged Mrs Elizabeth Janet Pitcher Care Home 38 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (38) of places Cromwell House DS0000027269.V360238.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Thirty-eight (38) Older People may be accommodated. Four (4) service users over the age of 65 years with a diagnosis of dementia may be accommodated. Maximum number not to exceed thirty eight (38). Date of last inspection 26th April 2007 Brief Description of the Service: Cromwell House is a residential care home and is one of a number of care homes operated by Methodist Homes for the Aged, which is a registered charity. It offers accommodation and personal care for up to thirty-eight people and is sited in a residential area of the city of Norwich, close to local amenities and the city centre. The home stands in its own grounds and is on two floors with a passenger lift to the first floor. All bedrooms are single and thirty-seven bedrooms have en suite facilities and the remaining one bedroom has a private bathroom next to it. There are two communal bathrooms and two toilets on each floor and those living at the home have communal use of a large lounge, two small sitting rooms with tea making facilities, a large dining room, conservatory and chapel for daily prayer and worship. The current range of weekly fees is £465 - £519. Cromwell House DS0000027269.V360238.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 that people who use the service experience Good quality outcomes. This unannounced inspection took place on Tuesday 26th February between the hours of 10: 20 and 17:40. The registered manager was absent as she was on sick leave. A deputy manager, temporarily seconded from another care home run by Methodist Homes For The Aged, took her place and was present throughout the day. This manager, along with all the members of staff spoken with in the course of the day, was pleasant and helpful in providing information about the service. Three senior members of the care team together with 3 carers and the activities co-ordinator were principle contributors but other members of the team were also at the home and observed going about their duties. A number of residents were spoken with informally and one person interviewed in private. In addition, 9 residents and 6 relatives commented to the Commission for Social Care Inspection (CSCI) by survey, as did 6 members of the staff team. The registered manager had completed and returned an Annual Quality Assurance Assessment (AQAA) to CSCI prior to her going on leave. What the service does well: What has improved since the last inspection? Cromwell House DS0000027269.V360238.R01.S.doc Version 5.2 Page 6 A number of concerns over the way medication was managed were raised at the previous inspection of April 2007. These problems had been addressed and clearer procedures were being followed to ensure the correct administration and recording of medication took place. The organisation had conducted its own quality assurance audit during the previous week. This had included a thorough audit of medication stocks, records and procedures all of which were found to be satisfactory. Corresponding observations were made during this inspection. A highly comprehensive care plan format had been introduced, including regular reviews and detailed information about residents’ needs. Staff had been trained in how to use the new system although it was noted this did remain problematic – see below. A number of rooms that were currently vacant had been redecorated and refurbished to a good standard, with new carpets and furniture provided. An activities co-ordinator was working with residents to ensure the care home made available opportunities for meaningful activities to take place. The care home had acted on the recommendation made at the previous inspection for female carers or carers of each sex to be available on night duty by adopting this as its’ policy. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cromwell House DS0000027269.V360238.R01.S.doc Version 5.2 Page 7 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 Cromwell House DS0000027269.V360238.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 and 6 Quality in this outcome area is good. Prospective residents had access to an informative Service User Guide that gave a rounded picture of life at the care home. People could be confident that they would only be admitted to the care home once their needs had been comprehensively assessed and there was agreement that these would be met. While the same procedures were applied to people only expecting to stay at the care home for a limited time, the shortterm objectives of those people should have been made clearer. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We examined the new Welcome Pack (Service User Guide) made available to anyone interested in moving to Cromwell House. The pack contained information about all aspects of the service together with some comments made by residents describing what it was like to live there. Cromwell House DS0000027269.V360238.R01.S.doc Version 5.2 Page 9 We also examined the revised Terms of Residence and the contract made between the care home and one of the people living there. This document was clear and covered all aspects of contractual agreement made between both parties and had been signed by a representative of the home and by the resident. The manager gave an account of how people who had expressed interest in moving to the care home were assessed to find out the nature of their needs and whether the home could meet their expectations. This was invariably done in the prospective resident’s own home or in hospital should they be there. Existing residents had come to the care home as a result of private arrangement or because social services had referred them to the service. A number of residents had chosen the care home because of its’ religious affiliations, but the manager stated that becoming a resident of Cromwell House was not dependent on a person belonging to the Methodist Church. The files of 5 residents were examined including those of 2 people who had been admitted for a short stay. The health and personal care needs of all these residents had been documented in detail in their files together with information about their social and emotional needs. A record had been made of their wishes regarding whether or not they wanted to be involved in the religious activities of the home and as to any form of spiritual support they might be seeking. While it was evident from conversation with members of the staff team that something was known of the background events that had lead up to one person coming for a short stay at Cromwell House, no account of this could be found in that person’s file. We also learned that another person had initially come there for a short stay but would probably be remaining as a permanent resident. In the Annual Quality Assurance Assessment (AQAA) returned to us the registered manager speaks of Cromwell House providing rehabilitative care in dedicated accommodation. This was not referred to in the files of the 2 people receiving short-term care which we examined during this inspection. A member of staff was asked if they could indicate where in the file information of this kind was kept (See following section- recommendation on care planning documentation), but they too were unable to find any evidence that differentiated the needs of that person from those of any of the permanent residents or gave any indication they might be going home again at the end of their stay. When ever a person is admitted to a care home for a short stay the objectives should be made clear so that staff can enable that person to achieve them. Similarly, if a person has entered a care home to see if they would like life there, with a view to possibly remaining there permanently, the proposition should be made clear and this information recorded in their file. Recommendation Cromwell House DS0000027269.V360238.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. The care needs of residents had been addressed in a wide-ranging plan that was detailed and regularly reviewed. The use of excessive documentation was alone a possible cause for concern in this as members of staff were evidently struggling to keep up with the record keeping expected of them. The management of medication had improved since the previous inspection. Residents were well supported and respected by the staff team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We examined the files belonging to 5 residents, including those of 2 people who had come to stay at Cromwell House for a limited period of time. Each file contained an extensive care plan. Health care needs, prescribed medication, tissue viability and risk of pressure areas developing had all been documented. The abilities of a person to mobilise themselves and any support they might need was described along with instructions to staff as to how this should be accomplished. Risks were fully considered and the action required to off set these set out for staff to follow. Nutritional needs had been assessed and a Malnutrition Universal Screening Tool had been used for this purpose in some Cromwell House DS0000027269.V360238.R01.S.doc Version 5.2 Page 11 cases. Emotional concerns had been examined and guides to the promotion of well being included in the plan. A persons’ social life, their life history in brief and family contacts were detailed. Their likes and dislikes, the kinds of activities they might consider engaging in were all documented. Where there were particular needs relating to a person’s diagnosed dementia this was also included in the plan. Each of these topics had a daily record sheet attached, together with records of monthly and 6 monthly reviews. Spiritual needs were described along with end of life wishes and instructions. Any accidents and their investigation were included in the file along with physical and psychological hazard checklists and a diary relating to a history of falls kept where applicable. Continence, personal hygiene and sleep patterns were accounted for along with observations entered by night staff. A record was kept of any visit by a health care professional and its outcome, as required at the inspection of April 2007. While the breadth of scope of each care plan together with the fullness of detail included was commendable, we felt that the format in which the information about residents was laid out was unwieldy. The inclusion of a daily record sheet for each separate area of need tended to result in the picture of the person concerned being less than cohesive. Members of staff spoken with said that despite having been trained in how to use these care plans, (introduced by the organisation responsible for the service in 2007) they continued to feel confused by them. The manager acknowledged that writing up their comments in the multiple daily record sheets was taking up the time of senior staff, time that might be better spent engaging with residents. A Recommendation was made for the organisation to review the effectiveness of the care plan format with a view to reducing some of the duplication of entries and arriving at a style of documentation that would be more user friendly to care staff and to those residents who might wish to take advantage of the provider’s offer to them, (contained in the Welcome Pack) to have access to their files. The requirement made at the previous inspection for the use of a handover book to be discontinued had been acted upon. A member of the senior staff team commented that because the handover book was no longer in use, some notes were taken to prepare for staff handovers but destroyed once they had served this purpose. A number of requirements were made at the previous inspection of April 2007 for the care home to improve the way in which medication was stored, administered and related records maintained. In the week preceding this inspection, the organisation had conducted its own quality audit, and this had included a full audit of all the medication held in stock. Only one fault had been found in the Medication Administration Record. On the day of this inspection these records were examined and seen to be fully up to date. A member of the senior staff team who had received training to do so was accompanied on a medication administration round and observed to offer Cromwell House DS0000027269.V360238.R01.S.doc Version 5.2 Page 12 medication to residents as prescribed in a competent and careful manner. Each resident had a Medication Profile Sheet, bearing their photograph, accompanying the Medication Administration Record and this detailed the medication currently prescribed and any necessary information as guidance to staff. The majority of medication was delivered by monitored dose system prepared by the issuing pharmacist. Other medication was clearly labelled and carefully administered in line with the guidance given by the organisation. Residents who self administered their medication had been assessed as capable to do so and their actions were monitored and recorded. Lockable storage was available in their rooms for them to keep their medication in. Medication managed by the care home was held in a purpose built trolley and this was secured to the wall of the medication storeroom when not in use. As previously required in April 2007 a step stool had been provided so that staff could safely reach high shelves in this room. A lockable medication fridge was provided and the temperature record showed this to have been regularly checked. A cabinet was also in place suitable for the safe storage of controlled drugs. A controlled drugs’ register was in use. Spot checks were made on the quantity of some controlled drugs in stock and on some medication prescribed to be given as required only (PRN) and stock levels were found to be accurate according to the records in both cases. The manager and senior staff confirmed that only senior members of the team who had received training to do so were authorised to administer medication and that two of these people (as opposed to just the one as had previously been the case) were now authorised to order and audit medication. The manager stated that it was no longer the care home’s policy to permit the administration of any homely remedies. However, a member of staff was observed administering cough syrup to a resident which, it was explained the resident had purchased for her own use. A Recommendation was made for the manager to check if this person’s GP approved the use of this syrup. During the course of this inspection a GP paid a visit to the care home and saw 3 patients, each one receiving a consultation in their own room. Residents spoken with were in no doubt that staff respected their privacy, and throughout the course of the day members of the staff team were heard talking to residents and observed behaving in a friendly but respectful manner towards them. Residents surveyed by CSCI and those spoken with during the inspection expressed confidence in the staff group, describing them as kind and friendly, keen to please and responsive. Cromwell House DS0000027269.V360238.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. Residents had opportunities to enjoy socialising with one another or to engage in meaningful activities. Life style at Cromwell House was relaxed and people benefited from the friendly atmosphere in the home. While there was some room for improvement to the provision of meals, it was evident that this had already been identified and was being addressed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the course of this inspection it was evident that the majority of residents of Cromwell House were enjoying opportunities to socialise with one another and were engaged in a variety of activities. On our arrival, the regular church service had just taken place in the home’s own chapel and residents who had taken part were enjoying coffee and biscuits together in the main lounge. Another person had just been out for a walk in the garden. A large and very complex jigsaw puzzle had been completed by some of the residents. The manager said this would be framed and put on the wall in light of the lengthy dedication it had taken to do this. Cromwell House DS0000027269.V360238.R01.S.doc Version 5.2 Page 14 Later that morning the care home’s mini bus was made available to take residents on an outing. One resident described frequently being able to go out in this way and said how much people enjoyed these trips, “even if it was just to go sight seeing in Norwich as many residents came from different parts of the county and weren’t very familiar with the city” adding that everyone enjoyed periodic trips to the seaside as well. The care home’s appointed activities co-ordinator, employed 5 days per week gave a good account of the way residents contributed to planning the activities she arranged and was knowledgeable as to their likes and needs. Future plans for activities, set out in the AQAA by the care home’s registered manager would, if acted on, further enhance outcomes in this area. In the course of the inspection the care home’s kitchen was visited by the Environmental Health Office with a view to completion of a periodic check on food hygiene standards. The cook in charge was on holiday and his place being taken by an assistant. It became evident that the assistant was unable to supply answers to all of the Environmental Health Officer’s questions and she decided she would return the following week when the cook would be on duty. The manager readily accepted that it was unsatisfactory for a person to be left in charge of the kitchens who was not completely conversant with the systems in place there and had already planned to raise this and other issues with the cook on his return. As a result no requirements were made but it was Recommended she ensure causes for concern were explored as soon as possible. During the inspection we were able to observe lunch being served. The dining room was clean and nicely appointed and it soon became evident how meal times provided another opportunity for residents to chat and socialise with one another. The atmosphere in the dining room was cheerful and friendly. The meal was served at an unhurried pace. Choices were clearly identified. Food appeared appetising, smelled good and was attractively presented. Portions were ample and additional helpings offered. Before the meal ended residents were advised of the choices in food available at teatime and able to place their orders. The choices for all the meals were advertised on a white board in the main foyer and in the dining room. Some resident’s surveyed and their relatives expressed the view that meals could be improved. Residents spoken with during the inspection said they thought the food good and one person said she thought the assistant cook had “done particularly well this week” in the absence of the cook in charge. However, one lady said she thought menus had been “rather repetitive and boring”. The manager had already noted how some residents held this view and taken steps to address the issue, producing a new set of menus she intended to ask the cook in charge to implement on his return to work. Cromwell House DS0000027269.V360238.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. Residents at Cromwell House were protected by policies and procedures put in place there. People had no doubts their concerns would be dealt with to their satisfaction. Members of staff had been trained to protect those living there from any form of potential abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Cromwell House complaints procedure was advertised at different locations in the home and contained in the Welcome Pack given to everyone who was resident there. People who were spoken with, and those residents and relatives who returned surveys to CSCI all expressed confidence in the management team and felt any concerns they might raise would be quickly and effectively dealt with. The manager had dealt appropriately with a minor concern that had been raised by a resident and information about this had been carefully recorded in the complaints’ log. No other complaints had been noted since the previous inspection. All members of the staff team had been trained on the need to protect vulnerable adults from abuse. All staff had received clearance by the Criminal Records Bureau. Members of the team spoken with were conversant with the whistle blowing policy and clear about what action they could take should it ever be the case Cromwell House DS0000027269.V360238.R01.S.doc Version 5.2 Page 16 they were unhappy about the way someone was being treated or their concerns were handled. Cromwell House DS0000027269.V360238.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23 and 26 Quality in this outcome area is good. Residents benefited from living in a clean, comfortable and well-maintained environment with good safety standards. Everyone could enjoy a room of their own while having access to spacious communal areas and a pleasant garden. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Upon our arrival, a tour was made of Cromwell House. All areas were found to be clean and tidy and free of any offensive odour. There were 2 domestic assistants who were in the process of completing their cleaning duties, one on the ground and one on the upper floor of the premises. The main lounge on the ground floor was spacious, well furnished, light and comfortable. The conservatory, which was also well furnished, and chapel were both accessed from this well used area. Windows from this room had an outlook over the extremely well kept and attractive gardens. There were 2 other small sitting rooms, one on each floor and where the manager said Cromwell House DS0000027269.V360238.R01.S.doc Version 5.2 Page 18 people could entertain their visitors. These rooms contained the facilities for tea making. The dining room and kitchen were both located on the upper floor. The dining area was well appointed and this too overlooked the garden. There was a good size lift providing access between ground and the upper level in addition to the stairways. Some members of staff, returning CSCI surveys commented that residents’ rooms were rather small and while few could be termed large rooms all were adequate and everyone who lived at Cromwell House benefited from having a room of their own. These rooms all had good size windows with a pleasant outlook, were light and airy but warm. All rooms had radiators that were covered and the hot water supplied to sinks was governed to safe temperature levels. All but one room had en suite facilities and the remaining room had an adjacent private bathroom. At the time of this inspection there were 6 vacant rooms at the care home. Since her arrival in December of 2007 the manager had overseen the redecoration and refurbishment of these rooms to a high standard. New furniture and carpets had been provided, bedding and curtains replaced. Other rooms seen had evidently been personalised by their occupants who had added, by example, pictures, furniture, televisions radios and plants. All of the residents spoken with said they liked their rooms and were comfortable there. There were 4 assisted bathrooms all of which were pleasantly appointed. As required at the previous inspection the manager had dispensed with the proliferation of notices from around the home, leaving a concentration on official notice boards instead, although a few notices that could have been tidier remained in the bathrooms. Access throughout the premises was good, with wide corridors, doorways and easy approaches in and out of the building. The care home had a well-equipped laundry and a laundry assistant responsible for processing residents’ and the care home’s laundry. Cleaning equipment was now stored in a locked COSHH cupboard. There were well promoted policies and procedures in place to help guard against infection. Members of staff said they believed they had all the equipment they needed at their disposal to help with this. The manager reported how an outbreak of winter vomiting early in December 2007 had greatly demoralised the staff team but this episode had rapidly been overcome and everyone was well again in good time for Christmas. The care home clearly had some difficulties finding a suitable place to store excess wheelchairs and a Recommendation was made for a solution to be found for this problem. Cromwell House DS0000027269.V360238.R01.S.doc Version 5.2 Page 19 The health and safety of everyone at the care home was promoted through policies and procedures and by the training offered members of the staff team. The premises had been risk assessed (2007) to help minimise the potential for an outbreak of fire and appropriate action taken by way of the provision of alarms and fire fighting equipment (all of which were checked and certified in early 2008) and training for staff. Cromwell House DS0000027269.V360238.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good but with some reservations noted. Residents were protected by the care home’s recruitment and selection procedures which were consistently good and by above average attainment of NVQ accreditation and the availability and completion of training. While staffing levels were appropriate to meet the needs of the existing number of residents it was essential that staff levels continued to match the needs of residents as and when the number of persons living at the home increased. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this inspection there were 32 people in residence at Cromwell House leaving 6 rooms empty. We examined the staff rota and spoke with members of staff on duty as well as with the manager. Our findings and the consensus of opinion was that staffing for this level of occupancy was acceptable. The manager had recently introduced a new 4-week rota that ensured staff only had to work one weekend in 4. This had the effect of improving the prospect of covering shifts made available through sickness. As a result there had been no call to enlist the help of agency staff in 2008. There were 5 members of care staff, including a senior carer of duty in the mornings and 4 in the afternoons. An additional person had recently been put on the staff rota to be brought on shift in the evenings to help prepare residents for bed. There were just 2 carers on duty at night, with one member of the senior staff team on call each night. Residents spoken with said they did Cromwell House DS0000027269.V360238.R01.S.doc Version 5.2 Page 21 not think they ever had to wait over long for attention, when they rang the call bell and said staff were usually prompt to answer. It had been noted however from surveys returned to CSCI by members of staff and some relatives that staff levels might not always have been sufficient late in 2007, despite a requirement made at the inspection of April 2007. The manager agreed that on her arrival at the care home in December 2007, staff morale following the outbreak of winter vomiting had been low. This had been reflected in staff surveys returned around the same time. There had been some staff vacancies and recruitment difficulties encountered. Since then, advertisements had been placed for additional staff and it was anticipated the care home would soon be fully staffed again. Given the lowered occupancy, existing members of staff were managing to cover all shifts. As and when occupancy increased, the manager should ensure that staff levels remain adequate at all times. The adequacy of night time cover should be included in this assessment and take account of the large size and layout of the care home as well as the assessed dependency levels of its’ residents. Recommendation The care home no longer employed 2 male carers to work together at night having acted on the recommendation made at the previous inspection for there to be female carers or carers of either sex available on night shifts. We examined the files of 3 members of staff. These files contained evidence of good recruitment procedures having been followed. Each person had completed an application form, been CRB checked and interviewed and 2 references had been provided. Staff had undergone appropriate induction and further training had followed on from this. Records of staff training showed that all mandatory training had been completed. In addition staff had been trained to understand the needs of people with dementia. In excess of 75 of the team had been accredited to NVQ Level 2 and some were currently working towards gaining Level 3. Staff meetings had been held at regular intervals throughout the past year with minutes taken. Cromwell House DS0000027269.V360238.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement reflected the overall management of the care home, rather than the concerns noted on the day of the inspection. We concluded that these failures had not directly affected the wellbeing of the residents, because a replacement manager, though unregistered had safeguarded their interests. It was though important the service providers clarified how they intended to ensure this remained the case during the continued absence of the registered manager. The needs and expectations of people who lived at Cromwell House were monitored through the organisations’ quality assurance system and findings used to inform future developments. The health and safety of both residents and members of staff were safeguarded by the organisations’ policies and procedures. This judgement has been made using available evidence including a visit to this service. Cromwell House DS0000027269.V360238.R01.S.doc Version 5.2 Page 23 EVIDENCE: At the time of this unannounced inspection the care home’s registered manager had been on sick leave since early December 2007 and remained so. No evidence of the organisation having informed us was available. A deputy manager from another care home operated by Methodist Homes for the Aged had been acting as manager of Cromwell House since late December 2007 but believed her term in post there would conclude at the end of February. She had not been informed as to if and when the registered manager was returning nor did she know who would be taking her place if she was not. A requirement was made for the registered providers to write without delay to CSCI informing us as to the arrangements they had in place for the management of the care home in the absence of the registered manager. Requirement Since her arrival at the care home, the manager had commendably worked to raise staff morale, ensure the safety and wellbeing of residents through improved organisation and deployment of the staff team, addressed issues of concern brought to her attention by residents and staff and worked with the handyman to improve the décor of the currently vacant rooms. Members of staff spoke highly of the manager and respected the efforts she had made to “pull the home up” since her arrival there. There was concern expressed by staff about “what happens next”. From observation, it was clear that residents were comfortable with the manager and regarded her as approachable and someone they could trust in. Members of the staff team had continued to receive regular supervision and annual appraisals had taken place. It was not the policy of the care home to handle cash on behalf of residents but everyone living at Cromwell House had a coded safe in their room as well as a lockable cabinet and a lock fitted to their bedroom door. Early in February 2008 the registered provider had implemented a full and thorough audit of the service (Standards and Values) as part of its own internal quality assurance system. It was recommended the findings from this audit should be summarised and made available to members of the public as part of the Welcome Pack. Recommendation. Some comments made by residents or gathered in previous surveys did appear in the literature already presented in the pack. Cromwell House DS0000027269.V360238.R01.S.doc Version 5.2 Page 24 Although evidence, in the form of reports, last in February 2008, produced by a representative of the registered providers showed that monthly inspections of Cromwell House had been conducted, in line with Regulation 26 of the Care Standards Act 2000, the last copy of such a report made available to CSCI was dated 2002. The registered providers must ensure a copy of Regulation 26 visit reports is sent to CSCI each month. Requirement The training made available to the staff team safeguarded the health and safety of everyone at Cromwell House. Details relating to how equipment was maintained were contained in the AQAA submitted in December 2007. Cromwell House DS0000027269.V360238.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 3 3 3 X X 2 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 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Cromwell House DS0000027269.V360238.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 OP31 Regulation 38 Requirement The service providers must inform CSCI as to how they intend to appropriately manage the care home in the continued absence of the registered manager. This was an immediate requirement made during the inspection of the home. 06/07 The service providers must ensure that copies of their reports on inspection visits they make to the care home each month are forwarded to CSCI Timescale for action 27/02/08 2. OP33 26 30/04/08 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 OP6 Good Practice Recommendations The objectives of a short stay care plan should be made clear in the resident’s file. If a person is admitted for a short stay with a view to familiarising them with residential care this too should be made quite clear in the plan and to them. The format of that care plans are produced in should be simplified and made more user friendly DS0000027269.V360238.R01.S.doc Version 5.2 Page 27 2. OP7 Cromwell House 3. OP9 Guidance should be sought from the GP of any resident who uses homely remedies they have purchased for themselves The registered person should monitor staffing levels as the vacancies for residents are filled to ensure staff numbers remain sufficient to meet the needs of all the residents both during the day and at night The registered person should investigate why someone was left in charge of the kitchen who lacked sufficient experience A suitable place should be found for storing the excess wheelchairs 4 OP27 5. OP15 6 OP19 Cromwell House DS0000027269.V360238.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cromwell House DS0000027269.V360238.R01.S.doc Version 5.2 Page 29 - 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. 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