Care Home: Cumberland Care Home

What the care home does well Staff were observed to have developed good relationships with people who use the service. Staff were seen to use touch and holding to provide comfort and support to individuals in a sensitive and individualised way. People who use the service are provided with good opportunities for activity and a stimulating environment. Individual visitors had very positive comments to make about the service. People told us ‘I feel I am in partnership with the home’ the service is ‘excellent’, ‘they are content’ and ‘I am very pleased with the level and type of care’. People who use the service are provided with good, informed choices of meals and snacks throughout the day. The changes in recording particularly around wound care provide good information for staff to provide the right treatment for individuals. Cumberland Care Home DS0000061986.V376738.R01.S.doc Version 5.2 All of the staff we spoke to were positive about the recent improvements in the service. Staff feel more engaged with care planning, risk assessments and activities. What has improved since the last inspection? Significant improvements have been made in the service since the last inspection. We found a marked improvement in communication and interactions between staff and people who use the service. The record keeping particularly in relation to wound care has significantly improved. All staff are more involved in care planning which is resulting in more person centred plans. One to one meetings are taking place to discuss individual care plans. We observed that relatives are being consulted on care planning which assists in ensuring that information is accurate and the service is working in partnership with others. Records now clearly show advice is sought from other professionals when needed and acted upon. Staff are assessing pain levels which assists in ensuring that no one is left with untreated pain. Staff have been provided with advice on working with individuals who may become angry and hit out. Medication has been reviewed and arrangements are in place for medication to be delivered to the service in time to address and shortfalls. The service management are reporting any issues which may possibly be a safeguarding matter without delay to the appropriate people. Staff training has been increased over the last few months which assists in ensuring that people who use the service are supported by a well informed staff group. Staffing numbers have been increased. We noted clear increases in the levels of activity and occupation for people who use the service. Improvements have been made to the environment including the installation of sensor lighting in en suite toilets which assists in reducing the risk of falls. The service has consulted with representatives of Dementia Voice to seek advice on further improvements in the environment. The acting manager has produced a clear plan for sustaining the improvements made in the service over the last few months. What the care home could do better: Cumberland Care HomeDS0000061986.V376738.R01.S.doc Version 5.2 Further work should be done to support staff in engaging with people who use the service who have difficulty with verbal communication and who may not always visibly respond. Consideration could be given to providing staff with the skills and time to carry out their own observations of life in the service on a regular basis. Further work could be done to support families, keep them informed of staff changes which may affect them or their relative and provide a more comfortable environment when visiting. Lounge areas could be made more interesting for individuals using the service with the addition of more interactive items. Key inspection report CARE HOMES FOR OLDER PEOPLE Cumberland Care Home 67 Whitford Gardens Mitcham Surrey CR4 4AA Lead Inspector Liz O`Reilly Key Unannounced Inspection 24th July 2009 09:00 DS0000061986.V376738.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. Cumberland Care Home DS0000061986.V376738.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 Cumberland Care Home DS0000061986.V376738.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cumberland Care Home Address 67 Whitford Gardens Mitcham Surrey CR4 4AA 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) 0208 646 1551 0208 646 5283 manager.cumberland@careuk.com manager.burroughs@careuk.com Care UK Community Partnerships Ltd Minkailu Sama Care Home 56 Category(ies) of Dementia (56), Mental disorder, excluding registration, with number learning disability or dementia (56) of places Cumberland Care Home DS0000061986.V376738.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of registration only:Care home with nursing - Code N to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE 2. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 56 1st April 2009 Date of last inspection Brief Description of the Service: The Cumberland Care Home is a purpose built facility situated in residential area of Mitcham. The property is detached and single storey with parking available on site. Public transport facilities are close by. The home is owned and managed by Care UK Community Partnerships Ltd, a subsidiary of Care UK plc. Care UK is a private company who own and manage a significant number of homes throughout the country. The home provides long term and respite nursing care and accommodation for up to 56 older people with dementia. Fees for this home range from £651.00 to £800.00. Cumberland Care Home DS0000061986.V376738.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 two stars. This means people who use this service experience good quality outcomes. This unannounced inspection was carried out by two regulation inspectors on 24th July 2009. The inspectors had the opportunity to speak with people who use the service, visitors to the service, staff and the acting manager. We looked at a sample of the records held in the home. One inspector used the Short Observational Framework for Inspection (SOFI). This involves detailed observation of the activity taking place for a small number of people with dementia in a communal area over a period of time. The acting manager has produced an action plan and a plan for sustaining improvements in the service. We have used information from all of these sources to reach the judgements made in this report. At the time of the last inspection of this service outcomes were judged to be poor for people using the service and a large number of requirements were made. Since then significant improvements have been made. However the challenge to the management and staff will be to maintain these improvements. What the service does well: Staff were observed to have developed good relationships with people who use the service. Staff were seen to use touch and holding to provide comfort and support to individuals in a sensitive and individualised way. People who use the service are provided with good opportunities for activity and a stimulating environment. Individual visitors had very positive comments to make about the service. People told us ‘I feel I am in partnership with the home’ the service is ‘excellent’, ‘they are content’ and ‘I am very pleased with the level and type of care’. People who use the service are provided with good, informed choices of meals and snacks throughout the day. The changes in recording particularly around wound care provide good information for staff to provide the right treatment for individuals. Cumberland Care Home DS0000061986.V376738.R01.S.doc Version 5.2 Page 6 All of the staff we spoke to were positive about the recent improvements in the service. Staff feel more engaged with care planning, risk assessments and activities. What has improved since the last inspection? What they could do better: Cumberland Care Home DS0000061986.V376738.R01.S.doc Version 5.2 Page 7 Further work should be done to support staff in engaging with people who use the service who have difficulty with verbal communication and who may not always visibly respond. Consideration could be given to providing staff with the skills and time to carry out their own observations of life in the service on a regular basis. Further work could be done to support families, keep them informed of staff changes which may affect them or their relative and provide a more comfortable environment when visiting. Lounge areas could be made more interesting for individuals using the service with the addition of more interactive items. 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. Cumberland Care Home DS0000061986.V376738.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 Cumberland Care Home DS0000061986.V376738.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): 1, 3, 5 & 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Admissions are not made to the home until a full needs assessment has been carried out. Each person is provided with a Service User Guide which gives information on what they can expect from the service. EVIDENCE: The organisation has produced a Service User Guide which provides information on what people can expect from the service. Each person using the service is provided with a copy of the Service User Guide. A copy of the guide was seen to be on display in the entrance hall. As noted in previous inspection reports consideration should be given to including the views of Cumberland Care Home DS0000061986.V376738.R01.S.doc Version 5.2 Page 10 people who use the service and or their representatives in the guide for those people considering moving in. We saw that before people are admitted to the service assessments of their individual needs are carried out. This ensures that the service is the right place for them and provides staff with some information on the individual which can be used to set up an initial care plan. Staff confirmed that they always receive copies of the assessments carried out before admission. Staff informed us that individuals who may be thinking about moving in are encouraged to visit the home before making any decision. In many instances the relatives of the person will visit the service on their behalf. Relatives we spoke to confirmed that they had been involved in making the decision and had visited the service. One person told us they had visited a number of homes in the area and chose the Cumberland because or the physical environment, the care they saw during the visit and that they ‘liked the manager and senior staff’. This service does not provide intermediate care. Cumberland Care Home DS0000061986.V376738.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): 7, 8, 9 & 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has made significant improvements in the provision of health and personal care to individuals who use the service. Personal health care needs are clearly recorded, regularly reviewed and action is taken to refer individuals to other health care professionals when needed. The recording of wound care has significantly improved. The health care needs of individuals are met. EVIDENCE: One relative we spoke to told us that they had chosen the service as they felt that it would provide good care but the home had not lived up to their expectations. However over the last six weeks they had noticed things had improved. We saw one relative being consulted by the acting manager on a Cumberland Care Home DS0000061986.V376738.R01.S.doc Version 5.2 Page 12 care plan. This person informed us that the previous care plan had not been accurate. Staff told us that they we much more involved in the care planning and assessments for individuals using the service. The staff we spoke to were happy with this and felt their involvement meant that more relevant and personal information was included in the care plan. The acting manager has produced an action plan to address issues raised by the Primary Care Trust and at the last inspection of the service. This plan indicated that care planning was now up to date and included relevant and individualised information for each person. We looked at samples of care plans on each unit of the service. We found clear improvements in the information made available to staff on the individual needs and wishes of the people they support. Staff have included good details of some of the strengths as well as the needs of people who use the service. This can assist in maintaining the independence of individuals. The personal likes and dislikes of people were seen to be recorded which assists in providing a more person centred approach by staff. At the time of the last two inspections of this service shortfalls were found in the recording of wound care. At this visit we found clear improvements in the way staff were recording the wound care provided. Staff were seen to have produced a wound care folder for each person who has a wound along with a care plan. Records gave clear information on they type of wound, the treatment required and the condition of wounds. Photographs are in place which assist in assessing any progress made in healing. Clear and up to date information on advice received from the Tissue Viability Nurse was available to staff. The records showed staff were providing treatment in line with this advice. Risk assessments were in place and actions had been taken to minimise any identified risk. Staff were seen to be carrying out an assessment of pain at each dressing and taking action to reduce any pain accordingly. The improvement plan for the service indicated that improvements had been made in assessing and supporting people who may become distressed and angry which may result in physical or verbal aggression towards staff or other people using the service. We found care planning and assessments provided improved information for staff in supporting people who have been known to become distressed and angry in the past. Records provide personalised information on possible triggers to this behaviour and advice on what may assist the person to feel calmer. The contact details of older people’s mental health care teams, whom staff can contact for advice, were seen to be available on individual files. The service has worked with the psychiatric services to review and reassess the needs of individuals. We noted, in one instance that the levels of medication Cumberland Care Home DS0000061986.V376738.R01.S.doc Version 5.2 Page 13 needed had reduced over the last few months. Staff informed us that this was due to the person feeling more secure and relaxed in the service. We found pain assessments were being used more frequently. This assists in ensuring that people who use the service, who may not be able to express they are feeling pain, are provided with pain relief. Discussions with staff indicated that they are alert to the individual signs that someone might be either unwell or feeling pain. Staff are monitoring the health of individuals and records showed that prompt referrals were being made to other professionals such as physiotherapists and dieticians when needed. We spoke to a visiting GP who made positive comments about the service. We found medication to be well managed. Records seen were up to date and accurate. Arrangements have been made, since the last inspection, to receive deliveries of medication further in advance so that any shortfalls can be dealt with. The medication prescribed to individuals is reviewed on a regular basis which ensures that people who use the service receive the right levels of medication. We observed staff supporting people in a considerate and gentle way. Staff were seen to respect the privacy and dignity of individuals offering assistance and suggestions in a discreet manner. Cumberland Care Home DS0000061986.V376738.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have opportunities to take part in a variety of activities. Information on the interests and routines of daily living for each individual are sought and recorded by staff. Meal times are unhurried and a variety of snacks are provided throughout the day. EVIDENCE: Staff are employed in the service to provide a variety of group and one to one activities seven days a week. An activities programme was seen to be on display. Activities available included arts and crafts, physical games, reminiscence and recall, walks to the town centre, bingo, card games, puzzles and Snoezelen which can assist some people with relaxation. “Chat” and “Rummage” boxes are available in the lounge areas which staff and visitors can use to engage with residents. Forthcoming events in July advertised in the service included visiting entertainers and a goodbye party for one person who was moving to another service. Cumberland Care Home DS0000061986.V376738.R01.S.doc Version 5.2 Page 15 One lounge is being used to show films which is identified with a chalkboard and signs advertising the film showing along with pictures of film stars on the walls. In the afternoon of this visit a large group of people watched Brigadoon. At the time of the last inspection of this service staff had informed us that they did not have time to get involved in activities, that they found it quite difficult to do activities and that it was one area which could be improved. At this inspection we found a marked improvement in the approach of staff with much more engagement with people who use the service either through structured activities or in one to one communication. Staff told us that the activities organiser had worked hard to get more people, including staff involved in activities and had added more materials for people to interact with in the corridors and lounge areas. The improvement plan for the service stated that Activities Based Care training would be revisited for all staff. Staff informed us that there had been several meetings about Activities Based Care. We observed staff engaging well with individuals with lots of physical contact through touch, kissing and stroking. Individuals who use the service were seen to respond well to this communication and support. Staff were seen to pay attention to the comfort of individuals, getting pillows and offering drinks. However generally, those individuals who were able to communicate verbally with staff received much higher levels of staff time and attention. People we observed were often left for longer periods without interaction usually either sleeping or in a withdrawn state. Each person received periodic interaction with staff but this could be increased. The challenge for staff is to look at how they can engage more frequently and effectively with people who have little or no communication. Consideration could be given to staff being provided with opportunities and training to carry out their own focused observation of daily life for individuals who use the service on a regular basis. The service offers a good variety of meals with two alternatives and a vegetarian option at lunch time and two options for sweet. We saw staff offering sausages and fish fingers mid morning as well as biscuits with a hot drink. People who use the service were seen to enjoy these savoury options which assist in adding calories to the daily intake. Visitors told us they felt welcome by staff in the service. We observed two visitors assisting people with eating in the dining room. One visitor, who visits very regularly, told us that their relative liked particular music but that they had only found this music being played on one occasion. Discussions with visitors indicated that they generally felt the service had improved over the last few months. As noted in other sections of this report improvements could be made in communication and the environment to make people who visit the service more comfortable. Cumberland Care Home DS0000061986.V376738.R01.S.doc Version 5.2 Page 16 A number of people were having breakfast when we arrived. People were seen to be allowed to eat at their own pace with staff taking time with individuals. At lunch time we saw menus displayed on the table in a pictorial form with staff also offering options when serving meals. Staff were seen to assist individuals with their lunch on a one to one basis in an unhurried and relaxed manner. One member of the domestic team was seen to assist people in a very positive manner, talking to the person they were assisting and others at the table which made the meal time more of a social occasion. Some of the staff could have interacted more with individuals but each person was seen to be supported in a sensitive manner. Cumberland Care Home DS0000061986.V376738.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): 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a clear complaints procedure which is on display. Staff been provided with additional training on safeguarding people. Clear instructions have been given by the organisation on reporting any concern or suspicion of abuse to the appropriate authority without delay. EVIDENCE: At the time of the last inspection of this service concerns were being raised regarding delays in reporting possible safeguarding issues. The current improvement plan for the service clearly states that any incident which has the possibility of being a safeguarding matter must be reported to the safeguarding team without delay. The acting manager has reported one issue to the local authority and notified the Care Quality Commission within twenty four hours. After further enquiries by the local authority this incident was found not to be a safeguarding concern. However the prompt action by the service indicates that staff are aware of their role and responsibilities in reporting any concerns they may have. Cumberland Care Home DS0000061986.V376738.R01.S.doc Version 5.2 Page 18 Staff informed us that they have had recently taken part in refresher training on safeguarding people. We were informed that no complaints had been received by the service since the last inspection. We were informed that a meeting had been held with relatives or representatives of people who use the service during which they were asked to give their opinion on the service and put forward any complaints or concerns they may have. This indicates to us that the management are open to comments on the performance of the service. Cumberland Care Home DS0000061986.V376738.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): 19 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are provided with a comfortable well maintained environment. Improvements continue to be made to make the environment more attractive and interesting for people living with dementia. The service was clean and fresh. EVIDENCE: People who use the service and relatives told us; ‘the staff work hard keeping the place clean’ that it was, ‘nice and clean’ and ‘they keep it pretty tidy’. Other comments we received were; ‘bit too clinical’, ‘not as inviting as it could be’ and ‘the reception area could be carpeted’. One person told us ‘it does smell of urine occasionally’. Cumberland Care Home DS0000061986.V376738.R01.S.doc Version 5.2 Page 20 The service invited representatives from Dementia Voice to advise them on possible improvements to the environment. Although at the time of this visit the service had not received the written report they had already started on some improvements. The improvement plan for the service highlighted a number of areas where it was felt improvements could be made to the environment. Sensor lights have been installed in en suite toilets to lessen the risk of falls. Televisions have been fitted to the walls in lounge areas to lessen the risk of injury to people who use the service. Plans are in place to further improve signage, the sensory garden and dining room. Work has started on painting bedroom doors in individual colours to help people with recognising their room. Future plans include making communal bathrooms and toilets more homely and less clinical. We found improvements had been made in the corridors of the service with lots of things for people to interact with. A number of people had added a short written life history by their bedroom door and memory boxes attached to doors included a variety of items relating to the person. A number of bedrooms had been personalised with the addition of ornaments, photographs and pictures. A cinema area has been produced from one of the lounge areas. We found improvements could be made in the lounge areas as quite a lot of space in these areas was not being used. We noted that in one bedroom visitors were either sitting on the bed or standing as there were no other chairs available. Consideration should be given to assessing where individuals usually meet with visitors and making these areas more comfortable for visits with chairs and small tables. All areas of the service we saw were clean and free from any offensive odours. Cumberland Care Home DS0000061986.V376738.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): 27, 28 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staff are available on each unit to meet the present needs of the people using the service. Staff are provided with very good opportunities for training which ensures that people who use the service are supported by a well informed staff group. EVIDENCE: We received positive comments about the staff group from people who use the service and relatives. People told us; ‘most of the staff are lovely’, ‘they look after me’, ‘they are really trying hard’ and ‘the people are very nice here’. One visitor we spoke to felt that more male carers would improve the service for their relative as they tended to respond better to a male carer. One relative told us that the key worker kept them informed of any changes or if their relative needed anything. However one relative did not know who the key worker or named nurse were as they believed the names on the notice in the bedroom were out of date. The acting manager informed us that prior to their taking over the management of the service key workers had been moved around the home. Consideration should be given to checking that relatives Cumberland Care Home DS0000061986.V376738.R01.S.doc Version 5.2 Page 22 know who the key worker and named nurse are and making sure that regular contact is maintained. We found sufficient staff available to meet the needs of people using the service at the time of inspection. Additional staff have been allocated to each shift throughout the day. In the morning seven staff are available on each unit with six staff available in the evening. A minimum of one nurse is on duty at all times in each unit. At night one qualified member of staff and two carers are available on each unit. New allocation forms have been introduced for both day and night to ensure that everyone is aware of their personal responsibilities during each shift. Staff we spoke to made positive comments about the recent changes in the service over the last few months. They told us that they were now more involved in the care planning and risk assessments, activities and that they were spending more time with people who use the service rather than focusing on getting tasks done. They felt there had been improvements in communication in the service, better team work and in morale. Staff confirmed that there were regular staff meetings and more frequent one to one meetings with senior staff to discuss individual care planning as well as more training. We found staff to have a very good understanding of the needs and strengths of the people who use the service. We observed a marked improvement in the quality of interactions and the amount of time spent interacting with people who use the service. Individual staff we spoke to had a clear understanding of their role in key working. Staff have been provided with a significant amount of training over the last few months which has included; pressure ulcer prevention and management, challenging behaviour, safeguarding people, moving and handling, activities based care, record keeping, dementia care, care planning, customer care and risk assessments. There is an on going training programme in place. Plans are in place to provide additional training for unit leaders and to provide exercises for staff to experience care ‘through a resident’s eyes’. Additional training in wound management has been arranged for September of this year with the Tissue Viability Nurse. Over 50 of care staff have achieved National Vocational Qualification (NVQ) to level 2 or above. The acting manager informed us that it is the intention to support all care staff to complete NVQ2 within the next twelve months. Care staff with NVQ 3 or who demonstrate excellence in care delivery will be offered opportunities to progress to senior care positions. Cumberland Care Home DS0000061986.V376738.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 & 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The acting manager has produced significant improvements in the service over a very short period of time. Opportunities for people who use the service and or their representatives to voice their opinions are provided. Staff carry out regular checks on the environment and equipment to ensure the health and safety of people who use the service. EVIDENCE: Cumberland Care Home DS0000061986.V376738.R01.S.doc Version 5.2 Page 24 Since the last inspection of this service the Operations Director for the organisation has taken over the management of the home on a temporary basis. A significant amount of requirements were made following the last inspection of the service. The management and staff have worked well to meet these requirements within the timescales set. The challenge for the staff team will be to maintain the improvements made for people who use the service. The acting manager is aware of the need for continuity in the improvements made and in further improving the service and has produced a clear plan for sustaining standards in the service. The Operations Director will retain day to day management of the service until a new manager is recruited. She will lead on the induction of the new manager and once induction is completed will reduce the time spent in the service subject to an assessment of the progress made. The Operations Director will make weekly visits to the service for a minimum of two months after the new manager takes over with the Regional Director also making weekly visits. The Operations Director will visit at least once a month for a period of six months after this time. The improvement plan also includes further training and personal development for unit managers, qualified nurses, care staff and Active Living Co-ordinators. Staff made positive comments about the acting manager. Individuals told us they felt well supported in their role and had received more frequent and better focused one to one meetings. Staff confirmed that staff meetings are taking place on a regular basis. Staff informed us ‘the manager is doing a fantastic job’, ‘gets things done’ and that the management of the service was ‘always on our backs, but this is a good thing’. Visitors told us that they were ‘very impressed’ by the manager. Regular meetings are held with the relatives of people who use the service. We saw the minutes of the last meeting which was held in July of this year. Issues discussed included the management of the service and progress to date, the environment, key workers and the garden. We looked at a sample of the records held on health and safety checks. These were found to be up to date. Testing of the fire alarm system is carried out each week with frequent fire drills. Staff are checking and recording the water temperature before supporting anyone with a bath or shower to reduce any risk of scalding. Cumberland Care Home DS0000061986.V376738.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 X 3 X 3 n/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Cumberland Care Home DS0000061986.V376738.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. Standard Regulation Requirement Timescale for action 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 OP12 Good Practice Recommendations Further work should be done to support staff in engaging with people who use the service who have difficulty with verbal communication and who may not always visibly respond. Consideration could be given to providing staff with the skills and time to carry out their own observations of life in the service on a regular basis. Lounge areas could be made more interesting for individuals using the service with the addition of more interactive items. Further work could be done to support families, keep them informed of staff changes which may affect them or their relative and provide a more comfortable environment when visiting. DS0000061986.V376738.R01.S.doc Version 5.2 Page 27 2. OP12 3. OP12 4. OP19 OP13 Cumberland Care Home Cumberland Care Home DS0000061986.V376738.R01.S.doc Version 5.2 Page 28 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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