Inspection on 29/01/09 for Cheam Cottage Nursing Home

This inspection was carried out on 29th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Cheam Cottage Nursing Home 38 Park Road Sutton Cheam Surrey SM3 8PY     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alison Ford     Date: 2 9 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Cheam Cottage Nursing Home 38 Park Road Sutton Cheam Surrey SM3 8PY 02086428997 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Marietta Dudhee,Mr Jugdutt Dudhee care home 19 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 19 The Registered Person may provide the following categories of service 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 Date of last inspection Brief description of the care home Cheam Cottage is a nursing home in Cheam Village, just to the rear of the high street and close to shops, local amenities and public transport links. The home is a listed building which has been extended to provide accomodation for up to 19 people who may have dementia. The home was registered to the current owners Mr and Mrs Dudhee in August 2008 and Mr Dudhee is also the Registered Manager. Since Care Homes for Older People Page 4 of 26 Over 65 0 19 Brief description of the care home purchasing the home the owners have embarked upon an extensive programme of refurbishment and redecoration which has all been done to a very high standard and in keeping with the original property. Although room sizes would not always comply with the standards expected of a new home, all of the rooms are now designed for single occupancy and some of them benefit from en-suite facilities. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was the first inspection of this home since it was acquired by the new owners Mr and Mrs Dudhee. Mr Dudhee has also been registered as the manager for the service. This report was written following a key inspection of the service although there have also been other visits made, to monitor the renovation of the home and to ensure that residents were safe during this time. We undertook a tour of the premises, and looked at a sample of care plans and documentation that the home is required to keep as evidence of its commitment to the health and safety of residents. Most residents have a degree of dementia and find it difficult to contribute to the inspection process however, we spoke with them and with a relative that was visiting. The home has sent us a completed Annual Quality Assurance Assessment which tells us about the home and their plans for the future and Care Homes for Older People Page 6 of 26 we have also taken into consideration notifications that the home has sent us of incidents that have occurred. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. As no new people have been admitted since the new owners acquired the home it is not possible to assess the effectiveness of the pre-admission process. Evidence: The key minimum standards relating to this outcome group are concerned with evaluating the the admission process. This includes an assessment undertaken by the home to ensure that people will be happy living there, that it will be suitable for them and the concerns that they have about moving in have been recognised and addressed. When the new owners acquired the home it was in a very poor state, needing total refurbishment and redecoration. They have concentrated on making it a more pleasant place for people to live in and as yet have not produced a new Statement of Purpose and Service User Guide. These documents will give people information about the homes aims and objectives and how they intend to deliver care and services. Care Homes for Older People Page 10 of 26 Evidence: There was previously an embargo on admissions funded by the local authority. The owners are hoping that this will be lifted once the refurbishments are completed. However, there have not been any new residents admitted since they purchased the home. Therefore it was not possible to assess the effectiveness of the pre-admission assessment process. A Statement of Purpose and Service User Guide must now be produced,in line with the regulations, which sets out the aims and objectives of the home and provides a guide for people who are currently living in the home or considering moving there. We will look at the pre-inspection process once the home is ready to admit more residents. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are having their health care needs met in a way which suits them however they may not always be protected by the homes medication procedures. Evidence: During the visit we looked at the care plans of 3 residents. They were generally in good order with evidence of input from other health care professionals, such as the Tissue Viability Nurse, as required. We could see that residents individual problems had been identified along with areas where they might need support in their daily lives. Factors which could lead to the development of pressure sores were being monitored and appropriate pressure relieving equipment was in place. Residents are all registered with one local doctors practice and they visit the home regularly. We looked at the storage and administration of medication. We noted that, where topical preparations had been prescribed, directions did not state where on the body this should be applied and they were not always signed for. Trained nurses administer medication in this home and all prescribed medication must be signed for, in accordance with UKCC Standards. Care Homes for Older People Page 12 of 26 Evidence: We also noted that not all record sheets indicated whether the resident had any allergies. It is recommended that this should be completed even if there are none, to show that it has been considered. In one instance we saw that medication had been prescribed on a when required basis. However there was no indication as to when this might be necessary. If medication is prescribed in this way there should be a care plan with explicit instructions as to when this should be administered. It was observed, that staff in this home treat people with respect and dignity. Personal care is provided in residents own rooms and staff appear to be kind and caring towards them. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People find that generally life in the home suits them although they would benefit from a wider range of activities to interest and stimulate them. Evidence: At the time of this inspection there were only seven people living in the home. This allows care staff to spend time interacting with them and currently they are also providing a limited range of activities for them. A relative that was visiting said that they felt more varied activities would improve residents lives although it is acknowledged that some of them have advanced stages of dementia and would not want to join in. We discussed this issue with the manager who told us that as the home begins to accommodate more people the resulting rise in revenue will allow more activities to be provided. There are also plans to develop the rear garden so that people can enjoy it during the warm weather. The local library now delivers new books to the home every 4 weeks and a hairdresser visits regularly. We were told that some people are able to be taken out of the home to the local shops and that visitors would always be welcome. We spoke with one relative during the Care Homes for Older People Page 14 of 26 Evidence: inspection who confirmed that they are always acknowledged and offered tea when the come in. The majority of people are very frail and the amount of choices that they are able to make are limited because of their remaining capabilities. However, they have been able to choose the activities that they participate in and the food that they eat. The person visiting told the staff that her mother preferred to sit in the front lounge so she could see passers by and this was addressed. The lunchtime meal was served during the vist. It looked appetising and people seemed to enjoy it. Everyone was offered a drink with their meal and there was help available for those who needed it. Menus are updated regularly to meet residents preferences. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that any concerns they may have will be addressed promptly however, they may not always be aware of the procedures to be followed. There are measures in place to ensure that they are protected from abuse. Evidence: There is a complaints procedure in the home however, it is not displayed in the home, neither is it available in any alternative formats to meet the needs of people who use the service. It will need to be included in the homes Service User Guide when this is produced. A relative, that we spoke with, told us that should they have any concerns they were confident that they would be addressed promptly. All of the staff employed at the home have had the relevant checks undertaken to ensure that people who have been judged as being unsuitable to work with vulnerable adults are prevented from doing so. They have all received training concerned with the recognition and reporting of abuse and those on duty at the time of this visit were able to explain the procedures to be followed. Care Homes for Older People Page 16 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If all of the refurbishment is completed as the owners tell us that it will be, residents will be living in attractively decorated home which meets their needs in a comfortable way. Evidence: The home is currently being completely renovated to a very high standard. Communal areas are being tastefully decorated and furniture, carpets and curtains replaced. Bedrooms would not always meet current regulations with regard to size however they are attractively colour coordinated with matching bedlinen and furnishings. Locks have been fitted to residents doors and self closing mechanisms, which operate in the event of a fire, are going to be installed. It was noted that the locks could mean that residents would be able to lock themselves in and the owners agreed to modify them. Disposable hand towels also need to be provided for staff to use when they are giving personal care to residents. Additional en-suite facilities have been provided in two bedrooms and communal bathrooms are being completely refitted with assisted baths. Attractive pictures and mirrors have been hung throughout the home. At the time of the inspection advice was being taken from the environmental health officer regarding extending the kitchen. Care Homes for Older People Page 17 of 26 Evidence: The nurse call system and fire alarm system have been replaced. Unfortunately the work is taking much longer than was originally anticipated. However once completed it will provide an attractive home for the people who live there. There are plans to improve the signage in the home to make it easier for people who are confused to find their way around and are also to improve the garden to make it more accessible and easier for residents to enjoy in the warmer weather. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are always enough staff available in the home and training will be provided which ensures that the needs of people who live there can be met. Evidence: On the day we visited there were enough staff on duty to meet the needs of residents living in the home and the rotas showed that this always the case. Nurses and carers are supported by domestic and ancillary staff and a cook. Staff that we saw were very kind and caring in their approach to people and seemed to have a good understanding of their problems. The majority of the care staff have achieved an NVQ qualification to at least level 2. No new members of staff have been recruited since the new owners took over. They have assured us that all necessary checks will be undertaken before anyone is employed. so that residents are protected from those who have been judged as being unsuitable to work with vulnerable people. Staff have received training in moving and handling and health and safety during the last year and other training is being planned for them. They receive regular supervision sessions which will identify any shortfalls in their training needs. Care Homes for Older People Page 19 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this 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 run in the best interests of the people who live there although there is currently no formal way for them to contribute their opinions and influence the services that are provided. Evidence: One of the owners of the home, Mr Jugdutt Dudhee, has been registered as the manager. He is a trained nurse with a great deal of experience in working with elderly people. As yet, there is no formal system in place to gain the views of the people who use the service although the manager is always available to speak with and address any concerns. A quality assurance monitoring tool will need to be introduced to ensure that residents are given the opportunity to comment on the services that they receive. The home does not take responsibility for the money of any of the residents. They all have relatives or representatives who can do this for them. Care Homes for Older People Page 20 of 26 Evidence: We have been advised that all of the equipment and services in the home are maintained appropriately. Once all of the building work has been completed we will need to have evidence that the work has been carried out in line with current building regulations. Fire fighting equipment and alarms are being replaced and it is also recommended that advice should be taken from the local fire safety officer to ensure that there are no further changes needing to be made. Accidents and incidents are being recorded and we are always informed about any incidents that have occurred. Care Homes for Older People Page 21 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 1 4 A Statement of Purpose and 30/05/2009 Service User Guide must now be produced,in line with the regulations. To set out the aims and objectives of the home and provide a guide for people who are currently living in the home or considering moving there. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 If medication is prescribed to be given when required there should be a care plan with explicit instructions as to when this should be. So that staff are aware of when this should be and people get their medication when it is necessary. 31/03/2009 2 9 13 All prescribed medication must be signed for, when it is given In order to provide evidence that medication is being given as it has been prescribed by their doctor. 31/03/2009 Care Homes for Older People Page 23 of 26 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 16 22 The complaints procedure must be displayed in the home and made available to residents and their relatives in a format which meets their needs. So that everyone is aware of the procedures that should be followed if they raise any concerns. 30/05/2009 4 32 24 There must be a formal 03/06/2009 quality assurance monitoring tool introduced. to allow people using the service to influence the care and services that they receive. 5 38 13 There must be evidence that 03/06/2009 all building work has been carried out in accordance with current building regulations So that we can be sure that the safety of people who are living in is assured. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 It is recommended that the box on the medication record sheet regarding allergies should be completed even if there are none, to show that it has been considered. Care Homes for Older People Page 24 of 26 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 2 12 It is recommended that consideration should be given to increasing the amount of organised activities that are arranged to interest and provide stimulation for the people who live in the home. It is recommended that advice should be obtained from the local fire safety officer to ensure that the home complies with current good practice guidelines. 3 37 Care Homes for Older People Page 25 of 26 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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