Inspection on 12/06/08 for Buttercup House

This inspection was carried out on 12th June 2008.

CSCI found this care home to be providing an Good service.

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

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Buttercup House 12 Radstock Road Woolston Southampton Hampshire SO19 2HP Lead Inspector Nick Morrison Unannounced Inspection 12th June 2008 11:00 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 Buttercup House DS0000071421.V363369.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. Buttercup House DS0000071421.V363369.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Buttercup House Address 12 Radstock Road Woolston Southampton Hampshire SO19 2HP 023 8047 2818 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) Mr Richard Edward Kitchen Mrs Elizabeth Kitchen Mrs Elizabeth Kitchen Care Home 20 Category(ies) of Dementia (0), Mental disorder, excluding registration, with number learning disability or dementia (0), Old age, not of places falling within any other category (0) Buttercup House DS0000071421.V363369.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP) 2. Mental disorder, excluding learning disability or dementia (MD). The maximum number of service users to be accommodated is 20. Date of last inspection Brief Description of the Service: Buttercup is a home providing a service to older people who may also have dementia or other mental disorder. The home is situated in a residential area of Southampton. Accommodation is provided in a mixture of shared and single rooms. The communal areas of the home consist of a dining room, lounge and a separate lounge/conservatory area/ Current fees in the home are between £405 and £450 per week. Buttercup House DS0000071421.V363369.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 stars. This means the people who use this service experience good quality outcomes. This report represents a review of all the evidence and information gathered about the service since the previous inspection. This included a site visit that occurred on 12th June 2008 and lasted five hours. During this time we went into each room, looked at service users’ files and met with people living in the home. We also met with the Manager and the Provider and spoke with two members of staff. All records and relevant documentation referred to in the report were seen on the day of inspection. We sent out a number of surveys and received replies from five members of staff, two service users, seven relatives of service users and two Care Managers. We have also referred to the Provider’s Annual Quality Assurance Assessment (AQAA). What the service does well: What has improved since the last inspection? The home has recently been registered by new owners and this is the first inspection since that time. The home was previously registered and many of the people who lived there at that time continue to do so. The feedback we have received from service users, relatives, staff and a Care Manager emphasise that there have been significant and wide ranging improvements to the service since the new owners have taken over. One relative told us the “care has improved, food is better, the house is cleaner, the residents are brighter and time is given to them so they are treated like people.” Buttercup House DS0000071421.V363369.R01.S.doc Version 5.2 Page 6 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. Buttercup House DS0000071421.V363369.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 Buttercup House DS0000071421.V363369.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, 3 and 6 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from having their needs assessed prior to moving into the home and have the information they need about the service. EVIDENCE: The home requires full assessment for all service users prior to deciding whether or not they can meet the person’s needs in the home. Service users’ files showed that these assessments were in place and had been completed prior to the person moving in. Assessments were comprehensive and contained details of all needs. Clear information about the service was available to all people moving into the home and each person had a copy of the Service User Guide in a folder in their room so that they and their relatives could refer to it at any time. Buttercup House DS0000071421.V363369.R01.S.doc Version 5.2 Page 9 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 This judgement has been made using available evidence including a visit to this service. Service users benefit from having their needs identified in a care plan and from having their healthcare needs met. They are protected by the home’s medication policies and procedures and are treated with dignity and respect. EVIDENCE: Each service user has a Care Plan in place. The new Manager is in the process of introducing a new Care Plan format that will improve the way the plans are written and make them more accessible to service users and their families. Some of the current Care Plans lacked detail about exactly how individual needs were to be met, but this is addressed in the new format. Some of the existing Care Plans had not been reviewed as regularly as they should have been. The Manager has assured us that the new Care Planning format will make it easier to track when plans need reviewing and that the home will ensure that all plans are kept under regular review. Buttercup House DS0000071421.V363369.R01.S.doc Version 5.2 Page 10 The health needs of people living in the home were monitored well. Records were kept on service users’ files about their current health needs and records also showed that needs were responded to in a timely manner and that people were supported to access the healthcare services they needed. The service liaises with the families of service users to ensure they are kept informed about their relative’s health needs. This was confirmed by a number of service users’ relatives and one told us “we are informed all the time of health issues.” Observation throughout the day of our inspection visit showed that people living in the home were well presented and had support to maintain their own appearance where necessary. Medication in the home was well managed. They use a monitored dosage system and keep good records of all medication coming into and going out of the home as well as good, clear records of all medication administered to people living in the home. All staff are receiving training through Southampton City College in administering medication. The medication in the home was stored safely in a locked room. The Provider and Manager were keen to ensure that all service users had regular medication reviews so that people did not end up taking medication for long periods if they did not need it. Feedback from all service users, relatives and staff confirmed that people living in the home were treated with respect and dignity at all times. One Care Manager told us they thought that the respect and dignity in the home was very good except that staff did tend to refer to service users with pet names. This was confirmed in our observation on the day of the inspection visit. It did not appear that staff meant to be at all disrespectful in using the terms they did, such as ‘darling’ or ‘sweetie’. However, the use of these kinds of words could be interpreted as patronising or just inappropriate. As a result, we have recommended that the home ensure, through the initial assessment process, that individual service users’ preferred forms of address are recorded and that staff in the home then respect this preference. There was significant feedback from relatives about the improvement in health and personal care in the home, including: “The difference in my mother-in-law and other residents is amazing considering the new owners have only been t here for a few weeks.” “We were previously very worried but the home now meets our relative’s needs” and Buttercup House DS0000071421.V363369.R01.S.doc Version 5.2 Page 11 “[my relative] is a lot happier and is kept looking a lot neater and tidier. Her hair and nails are being well kept and she is bathed and washed regularly now so the skin on her legs and feet looks so much better.” Buttercup House DS0000071421.V363369.R01.S.doc Version 5.2 Page 12 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 This judgement has been made using available evidence including a visit to this service. Service users benefit from being able to exercise choice and control and have stimulating activities. They also benefit from good support in maintaining contact with friends and families and a good, balanced diet. EVIDENCE: The home provides a range of activities to ensure that people living there receive stimulation and are able to interact with others. Entertainers are brought into the home and there are also bingo and music therapy sessions. In addition, staff spend a lot of time interacting with service users and promoting socialisation among all the people living in the home. On the day of our inspection visit there was a music session taking place facilitated by someone outside of the home. Many service users were taking part and there was a lot of support, encouragement and direction for people to be involved in a meaningful way. Other service users chose not to be involved in the activity, but staff ensured they had other things to do such as watching the television or reading newspapers. Buttercup House DS0000071421.V363369.R01.S.doc Version 5.2 Page 13 People living in the home were supported to maintain contact with their families and friends. Records showed there were regular visits and that staff kept in touch with families to ensure they were kept up-to-date with what was happening with their relative. One person living in the home is supported to spend time at home with her husband two or three times a week. The Provider has given her mobile telephone number to all relatives of people living in the home so that they are able to contact her at any time with any concerns or questions. Families were encouraged to visit the home at any time that was convenient to them and their relative. Feedback from relatives confirmed this and that the staff in the home always made them feel welcome. One relative told us “the home makes visiting a pleasure.” Another told us “the home now helps us keep in touch.” The home is aware of the need for people to maintain relationships and makes every effort to support them in doing so. Individual sexual orientation is acknowledged in addressing people’s needs. One person living in the home had brought her parrot to the home with her and his cage was in a communal area and was a source of amusement to other people living in the home. Observation during the inspection visit showed that staff were aware of the need to interact with people living in the home throughout the day. They were skilled in communicating with people and there was a system in place so that staff were able to use visual aids to communicate throughout the day with people who were deaf or hard of hearing. The food in the home was of good quality. The food storage area showed that only good quality food was purchased for the home and menus showed that a range of nutritious meals were available. People living in the home told us the food was good and that they received sufficient portions. This was supplemented by fresh fruit, crisps and sweets being available to all service users throughout the day. The kitchen area was well managed and kept very clean. The cook understood the different preferences and needs of people living in the home and all diets were catered for. Buttercup House DS0000071421.V363369.R01.S.doc Version 5.2 Page 14 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 This judgement has been made using available evidence including a visit to this service. Service users benefit from a clear and effective complaints procedure and are protected by the home’s adult protection procedures and practices EVIDENCE: The home has a Complaints Policy in place and this has been made available to all service users and their families. A copy of the policy was also kept in the Service User Guide in each service user’s room. People told us they were aware of how to complain if they thought they needed to. There was a system in place to ensure that all complaints were recorded and responded to in line with the Complaints Policy. There had been no complaints. Systems were in place through policies and staff training to ensure that people were protected from abuse. Staff were aware of their role within this and the Manager was aware of the local reporting procedures for any suspected incidents of abuse of any kind. No such issues had been identified in the home and all he feedback we got from people suggested that they felt that people living there were safe. Buttercup House DS0000071421.V363369.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from living in clean, safe, well-maintained environment. EVIDENCE: The new owners have spent a lot of time improving the physical aspect of the home. There has been re-plastering throughout most areas of the home and new fire doors had been fitted to service users’ rooms with locks that were appropriate to their needs. A new floor had been laid in one of the bathrooms and plans were in place to do the rest. A downstairs bathroom had been refurbished, but needs to have a privacy lock fitted to it. The Provider has told us this will be addressed. Buttercup House DS0000071421.V363369.R01.S.doc Version 5.2 Page 16 The communal areas of the home have been improved, including a conservatory and courtyard area that is used for parties or for visits from relatives, friends and Care Managers. The furniture and fittings in the home have also been improved including new chairs, beds, bedding, carpets and curtains. The Provider has further improvements planned. Feedback from staff confirmed that the home is much better decorated now and provides a much better environment to live and work in. One member of staff expressed a concern that there was no cleaner in the home. In discussion with the Provider it was confirmed that the cleaner had left and that they were in the process of recruiting a new cleaner. In the meantime there were cleaning schedules in place that were followed by members of staff and the home appeared clean and hygienic throughout, while maintaining a homely atmosphere. Feedback from relatives confirmed that the home is now being kept very clean. Buttercup House DS0000071421.V363369.R01.S.doc Version 5.2 Page 17 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 This judgement has been made using available evidence including a visit to this service Service users benefit from being supported by adequate numbers of sufficiently trained staff and are protected by the home’s recruitment policies and practices. EVIDENCE: There is a senior member of staff on duty with two carers throughout the day. This is in addition to the Manager who works full-time. At night there is one member of staff asleep and one awake. The Provider told us there is provision for the sleeping member of night staff to remain awake during the night if the changing needs of people living in the home suggest it is necessary. The Provider and Manager also told us they are planning to provide an additional member of staff at weekends and in the evening in the future. A concern had been expressed by one member of staff that there were regular occasions when a nineteen-year-old member of staff was left in charge of the home. This was disputed by the Provider who told us there were no members of staff in the home who were nineteen. Buttercup House DS0000071421.V363369.R01.S.doc Version 5.2 Page 18 We asked the Provider how decisions about who was left in charge of the home were arrived at. She told us that it would depend more on an individual’s competence and experience rather than their age. She also told us there was always telephone support available twenty-four hours a day from her, her assistant and/or the Manager of the home, either of whom would attend the home if necessary. Records showed that support and supervision for all staff is being introduced and staff meetings have recently begun. The recruitment records showed that all necessary pre-employment checks are undertaken prior to staff working in the home. In discussion the Manager demonstrated an awareness of ensuring the safety of people in the home by implementing a rigorous recruitment process. Feedback from staff was positive. They told us “There is sufficient staff now” “We have been told we will be doing more training including NVQ.” And “[Managers] check that we are happy with work procedures.” A Care Manager told us “staff are approachable and willing to work with residents and their families to put things right for them.” A relative told us “the carers are wonderful.” Buttercup House DS0000071421.V363369.R01.S.doc Version 5.2 Page 19 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, 36 and 38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users are protected by the home’s financial procedures and by the management of health and safety issues. EVIDENCE: As part of the new Provider’s registration we had asked her to ensure a fulltime Manager was put in place at the home as soon as possible. The home has now appointed a new Manager who is experienced in managing services. He is in the process of applying to become the Registered Manager of the home. Although he had only been at the home for two weeks at the time of our inspection visit, it was clear that he had identified areas for improvement and Buttercup House DS0000071421.V363369.R01.S.doc Version 5.2 Page 20 development and had already addressed some issues as well as putting plans in place to deal with others. In discussion on the day of the inspection visit, and within the Annual Quality Assurance Assessment (AQAA), the Provider acknowledged that the Quality Assurance process within the home needs to be developed, implemented and needs to include a wide range of stakeholders. The new Manager has experience of working with Quality Assurance systems and plans to develop this over the coming year in line with the National Minimum Standards. He also told us he was planning to introduce service user meetings for people living in the home and their families. No outstanding Health and Safety issues were identified throughout the course of the inspection process. We received very good feedback from service users, relatives, staff and Care Managers about the improvements in the home since the new Provider and Manager had taken over. Staff told us “The owner has explained her high standards and expectations to all staff.” And “We feel we can talk to the Provider, the Manager and Senior Carers.” One member of staff told us they thought the “new owner did not treat everyone the same and can be verbally intimidating.” No one else suggested anything similar to this and we found no evidence on the day of the inspection that this might be the case. We also found, from observation and feedback from a wide range of people, that the Provider was approachable and responsive with an obvious and demonstrable concern for people using the service. Relatives told us “The new owner has made vast improvements in all areas.” “The new owners are keeping us informed of changes.” “The new owners are creating a family atmosphere.” “[The home is] continuing to improve above all expectations.” And Buttercup House DS0000071421.V363369.R01.S.doc Version 5.2 Page 21 “It is now being run more professionally with much higher standards.” A Care Manager told us “Managers expect high quality of care and respect for residents.” Buttercup House DS0000071421.V363369.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 3 X 3 X X 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 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 2 X 3 3 X 3 Buttercup House DS0000071421.V363369.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? N/A 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 OP10 Good Practice Recommendations The preferred form of address for each service user should be recorded and should be respected at all times. 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