Inspection on 23/04/07 for April Cottage

This inspection was carried out on 23rd April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

April Cottage 28/04/08

April Cottage 12/10/05

April Cottage 21/06/05

April Cottage 25/11/04

April Cottage 07/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE April Cottage 1 Park Road Selsey Chichester West Sussex PO20 0PR Lead Inspector Val Sevier Unannounced Inspection 23rd April 2007 10:45 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 April Cottage DS0000014364.V331740.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. April Cottage DS0000014364.V331740.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service April Cottage Address 1 Park Road Selsey Chichester West Sussex PO20 0PR 01243 602450 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) Dr Hugh Charles Condon Dr Catherine Helen Condon Mrs Elaine Elizabeth Davitt Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places April Cottage DS0000014364.V331740.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th October 2005 Brief Description of the Service: April Cottage is a detached property situated in a quiet residential part of Selsey, within walking distance of local shops and the sea. There is a spacious garden surrounding the home and car parking space. The accommodation is arranged on two floors, comprising of two single bedrooms on the first floor and eighteen bedrooms on the ground floor. The first floor is accessible by stairs. Communal rooms comprise of a large lounge/dining room and a smaller lounge. The fees for the home range between £400 and £480 per week. The home is owned privately by Dr H and Dr C Condon and managed by Mrs E Davitt. April Cottage DS0000014364.V331740.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The findings of this report are based on several different sources of evidence. These included: an unannounced visit to the home, which was carried out on the 23rd April 2007, during which there was discussions with the manager, staff and residents. In addition 4 relatives had completed questionnaires prior to the visit. During the visit to the home a tour of the premises was carried out with where possible, permission of the residents at the home, this also included their rooms. Staff and care records were sampled and in addition to speaking with staff and residents, their day-to-day interaction was observed. All regulatory activity since the last inspection was reviewed and taken into account including notifications sent to the Commission for Social Care Inspection. The home completed a pre inspection questionnaire, which was also used to inform the report. What the service does well: The home carries out an initial assessment of the care needs of the individual, which is then followed through after the person has moved to the home. The manager and staff were able to verbalise their understanding of the needs of the residents. There is a ‘homely’ feel to the home, with what appears to be a good rapport between the residents and the staff. This was seen during the visit with support for individuals with communication needs such as hearing loss. People who use the service are enabled to access the community facilities such as clubs and the church as well as the local village and Chichester. All people spoke to on the day commented on the quality of the meals and that they could have what they wanted, if they did not want what was on the menu that mealtime. There is a clear complaints process and relatives have commented how open the staff are to discussions about the care of the people who use the service. The home is maintained well and clean and tidy. People who use the service are enables to take personal possessions to personalise their rooms. April Cottage DS0000014364.V331740.R01.S.doc Version 5.2 Page 6 There is a robust recruitment of staff who have received training in all mandatory areas and who have received training to meet particular individual need. The manager and staff expressed a clear understanding of the needs of the people that live at the home and the home appears to be managed generally well with their interests at the centre of the care provided. What has improved since the last inspection? 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. April Cottage DS0000014364.V331740.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 April Cottage DS0000014364.V331740.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): 3 (6 is not applicable at this home). People who use 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 home has a satisfactory understanding of the residents needs using the assessment process. EVIDENCE: The inspector looked at three care plans and each individual had had an assessment prior to moving to the home. The assessments contain information about the needs of the individuals. It was observed that the information gained through the assessment had been used to complete the care plans. The exception to this was where individuals who need support with their mental well-being for example learning difficulties and poor short term memory. The assessments are carried out before admission, on the day of admission, a week later, a month later and then the tool is used to monitor the needs of the individual. April Cottage DS0000014364.V331740.R01.S.doc Version 5.2 Page 9 Relatives who have commented, explained what had happened in the decisionmaking process regarding the home and how they had been involved. Some residents spoken with although able to speak for themselves had been unable to visit the home due to physical frailty. The relatives commented that the admission process had worked, that they had been given adequate information to assist with the decision, making process. The relatives felt that the needs could be met at the home. One resident had been coming to the home on a regular basis for respite, after returning home after a visit they felt unable to manage and requested a permanent stay. The home was able to accommodate this and the move has worked well for the individual knowing the home so well. April Cottage DS0000014364.V331740.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, 10 & 11 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home is generally able to provide aids and support for the needs of people who use the service. Medication systems do not always follow safe practice guidelines and may place people who use the service at risk. EVIDENCE: There were 19 people accommodated at the home on the day of the visit, the inspector sampled three care plans. The care plans have personal information such as ‘likes to be called’, previous medical history and reason for admission, picture of the individual and next of kin details. The care plan consists of two main sheets; one briefly identifies area of need and action to be taken by staff to give the support. An example, which was repeated where the need was the same, was for bathing ‘unable to bath self’, ‘give bath once a week using hoist’. April Cottage DS0000014364.V331740.R01.S.doc Version 5.2 Page 11 The manager stated that staff make notes in a daily diary, which she then transfers to a typed record, the records seemed to be when there was an occurrence for the individual, such as optician visit or chiropody or going out. There was evidence of visits by the doctor when concerns were identified and follow up action. Resident’s comments included that they had seen the optician recently, and one individual was very pleased with their new glasses. One person, who was hard of hearing, had a notebook, which staff used to communicate with them. There were risk assessments, which were around mostly general needs at the home such as bath hoist, hot water and radiators, others were more specific for the individual such as smoking and using a walking stick. The manager stated that one individual does not like to be disturbed during the night, is given their night medicine to take themselves and the staff do not go to the room at all. There was however no assessment to support this. One individual was noted to have a catheter, which the district nurse changes every three months, home staff care for it in the meantime however there was little information on how staff would do this. The manager stated that there was an individual who had pressure sores, which were treated by the district nurse, who also maintained the notes for this. Another individual had been discharged from hospital with infections, it was seen that there was some information on how staff were to manage this, to help with the prevention of cross infection. Relatives spoken with were involved in the care planning having meetings with the manager. They felt this was important, as the residents although involved, due to their personal issues are not always able to give information or informed consent. The consultation was also appreciated, as the relatives spoken with had been the carers for in some cases years, and they felt that this kept them involved in the care. It had been seen on care plans that the preferred choice of name had been recorded and staff were heard to speak to residents by the name they wished and staff were observed to interact with residents with respect. The inspector looked at the medication administration records, storage and control of stock. The records evidenced that there was good stock control with adequate supplies. It was noted in the medication policy that that there is a returns medication book, which is signed and dated by the chemist. There are Controlled Drugs prescribed for residents these were seen to be recorded and stored as guidelines suggest. The manager had a 2005 British National Formulary book with information about medication. At the time she was unable to find the Royal Pharmaceutical Guidelines, which also assists homes with managing medication. Following the inspection the manager contacted CSCI and advised that they did not have a copy. April Cottage DS0000014364.V331740.R01.S.doc Version 5.2 Page 12 It was noted on one of the three care plans seen, that the individual was unable to manage their own medication. The inspector asked if other residents looked after their own medicines. One individual has their own pain relief and sleeping tablet. There was no evidence of an assessment having been carried out to support this. It was noted that there were 45 gaps in the Medication Administration Record (MAR), where it was unclear whether the medication had been given. Generally there was no evidence where ‘as needed’ medication was given, as to the reasons it had been administered and whether the outcome was effective. It was noted that in some cases where a medication had been prescribed there were gaps, as staff had felt that it was not needed. There was evidence that where a medication was prescribed to be given ‘as needed’, it had been given regularly in one case daily. For on individual who was to receive either one or two tablets, there were gaps and also no record of whether one or two tablets had been given. The inspector noted that one individual is prescribed Warfarin in 1mg, 3mg and 5mg tablets. The dosages are monitored by regular blood tests and an email is sent to the home advising them of the doses to be given. There were no records that staff had given the prescribed medication. The residents spoken with commented that they felt treated with respect and dignity regarding medication. Not all care plans seen had end of life wishes, the manager says that this is looked at individually with the person. One has worked with the manager on their ‘end of life care plan’, as they have expressed their wishes regarding hospitals, for example. April Cottage DS0000014364.V331740.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 & 15 People who use 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 the service have choice in their daily lives and their individual interests are encouraged. EVIDENCE: April Cottage has an individual who works at the home four hours week (over two days). This person takes people out, does individual shopping, reads plays games or anything that the residents would like to do. A notice in the hall way indicated that there are six weekly ‘music for health’ afternoons arranged throughout the year. On the afternoon of the inspection, some residents had returned to their rooms for a rest, some dozed in the lounge and some chatted or watched the television. Some residents choose to attend community clubs, activities and churches such as the Torch blind club. A Venture bus is available in the area and offers transport for a cost of £7.50 per year, to Chichester, the local village, health centre or Church. One resident regularly has a holiday to a local caravan park. April Cottage DS0000014364.V331740.R01.S.doc Version 5.2 Page 14 Several people commented that the food was very good and that they could have what they wanted if they did not like the menu that day. It was noted that there was a record of breakfast lunch and suppers and individuals choices and alternatives had been recorded. One individual was noted to have a different breakfast each day, depending on what they felt like. Staff were noted to sensitively help residents with their lunch as necessary. April Cottage DS0000014364.V331740.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 & 18 People who use 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. Staff have knowledge and understanding of Adult Protection issues which protects the people who use the service from abuse. Individuals can be confident that their views are known to staff and are fully taken into account. EVIDENCE: There have been no complaints or allegations of concern made since the last inspection to the CSCI. Relatives who returned comment cards were aware of how to complain and said they felt comfortable in speaking with the staff about any issues. The home had a copy of the Sussex Adult Protection procedure so that the manager and staff could refer to it when necessary. The pre inspection questionnaire completed by the home stated that all staff have recently undertaken a long distance training course in adult protection. The manager confirmed this on the day of the visit. April Cottage DS0000014364.V331740.R01.S.doc Version 5.2 Page 16 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 and 26 People who use the service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to this service. April Cottage provides a comfortable and homely environment. EVIDENCE: The location and layout of the home is suitable for it’s purpose. It is accessible and well maintained; meeting resident’s needs. The manager said that maintenance and decoration of the home is carried out as necessary. The home’s gardens are accessible to residents and they are maintained to a high standard by a gardener. All bedrooms are comfortably furnished and equipped to meet the needs of residents. Residents expressed satisfaction with their rooms and enjoyed having a number of their own possessions around them. April Cottage DS0000014364.V331740.R01.S.doc Version 5.2 Page 17 The bedroom doors are linked up to the fire alarm system that enables residents to have their doors open if they so wish, whilst ensuring doors would automatically close in the event of the fire alarm being activated. The current residents have chosen not to use door keys. The manager stated that she would lock any valuable items away for residents, but they are generally discouraged from bringing items of value into the home. The home employs a domestic and care staff do the laundry. The home was seen to be clean and tidy with no malodour. The care staff return the residents clothing to their rooms once it has been attended to. April Cottage DS0000014364.V331740.R01.S.doc Version 5.2 Page 18 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 & 30 People who use the service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to this service. The home provides sufficient numbers of staff who are trained to meet resident’s needs. EVIDENCE: The staff rotas were seen and it was noted that there are two staff on duty throughout the twenty-four hour period. The manager is at the home daily Monday to Friday and available by phone outside of her working hours, living in the village. In addition to the care staff there is a domestic, a cook and a gardener. Youngsters from the local school are employed to assist with supper and it was noted that the school had been involved in risk assessing the situation and deciding on their roles. These individual had also been CRB checked and references obtained. The inspector sampled two staff files and it was noted that the manager had undertaken the necessary checks to protect the residents this included two references and an Enhanced CRB check. The manager supplied information on the training undertaken by staff and planned for the year. New staff received induction that includes working supernumerary for several shifts and mandatory training such as moving and April Cottage DS0000014364.V331740.R01.S.doc Version 5.2 Page 19 handling. The manager showed the inspector the ‘Skills for Life’ induction, which she is going to use at the home. April Cottage DS0000014364.V331740.R01.S.doc Version 5.2 Page 20 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 &38 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. There are areas of improvement in the management of the home needed to ensure that people who use the service are protected. However generally the home is well run with the interest of the people who use the service foremost. EVIDENCE: The manager has been at April Cottage for 17 years, having previously been a manager at another home. Mrs Davitt is qualified as a nurse although she is not employed in this capacity at April Cottage. Mrs Davitt has undertaken training recently in falls prevention and has updated herself in mandatory areas such as food hygiene. She is also a qualified NVQ assessor. April Cottage DS0000014364.V331740.R01.S.doc Version 5.2 Page 21 The manager carries out a Quality Assurance yearly, giving questionnaires to relatives, residents at the home and other visitors such as the doctor, district nurse and hairdresser. Most residents control their own money and/or have family who do this on their behalf. The manager is the appointee for one resident. Records are kept of incoming and outgoing payments to protect the interests of the resident. However the individual’s pension is paid directly into the manager’s personal bank account. Staff said that they feel the manager has an open-door policy and is very involved with residents and staff in the day-to-day life at the home. The manager stated that staff receive formal supervision from her every two months. The policy for staff supervision was seen with the information sent with the pre inspection questionnaire, which outlines the management of supervision and confirms the manager’s open door management. is includes looking at training needs and aspects of practice. Records showed that staff have an annual appraisal. Staff have been trained in safe working practice topics, e.g. infection control, first aid, moving and handling. Any substances that may be hazardous to health, e.g. cleaning fluids are securely stored. The manager has undertaken risk assessments. Fire records were seen and it was noted that all checks had been carried out as needed, and staff receive fire training/awareness regularly. April Cottage DS0000014364.V331740.R01.S.doc Version 5.2 Page 22 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 1 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 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 2 X X 3 April Cottage DS0000014364.V331740.R01.S.doc Version 5.2 Page 23 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 When medication is administered to people who use the service it must be clearly recorded. This will ensure that people receive the correct levels of medication. Pensions must be paid into the persons own bank account even if the manager is appointee and this is line with In Safe Keeping, CSCI guidance. . Timescale for action 23/05/07 2 OP35 20(1) 23/06/07 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 Guidelines, such as The Royal Pharmaceutical Guidelines, would assist with protecting the people using the service in regards to policies and procedures of the storage, recording and administration of medication. People using the service should be able to manage their own medication within an appropriate risk assessment DS0000014364.V331740.R01.S.doc Version 5.2 Page 24 2 OP9 April Cottage framework to promote their independence. April Cottage DS0000014364.V331740.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 April Cottage DS0000014364.V331740.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!