CARE HOMES FOR OLDER PEOPLE
China Cottage Nursing Home 154 Owston Rd Carcroft Doncaster South Yorkshire DN6 8EA Lead Inspector
Ian Milner Key Unannounced Inspection 09:00 2nd August 2006 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 China Cottage Nursing Home DS0000053683.V302580.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. China Cottage Nursing Home DS0000053683.V302580.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service China Cottage Nursing Home Address 154 Owston Rd Carcroft Doncaster South Yorkshire DN6 8EA 01302 724815 01302 728312 manager@ccchdd.eclipse.co.uk 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) Doncaster Property Investment Fund Ltd Mrs Sandra Thomas-Blount Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places China Cottage Nursing Home DS0000053683.V302580.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service may admit persons between the ages of 60 - 65 years. Date of last inspection 16th March 2006 Brief Description of the Service: China Cottage is a care Home registered to provide personal care and nursing care for up to 33 persons in the category of older adults. The Home is situated in the village of Carcroft, which is about six miles from the town of Doncaster. It is a two-storey building with 29 single and 2 double bedrooms. There is a passenger lift to facilitate access between the floors. Accommodation for residents is provided on both floors. The lounges, dining areas, kitchen and laundry facilities are located on the ground floors. There is also a hair dressing facility for residents. There are patio and lawn areas at the rear of the Home and car parking spaces to the front. China Cottage Nursing Home DS0000053683.V302580.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on 3rd August 2006 and lasted for seven hours. In addition to a tour of the premises, the inspector spoke to seven service users and five visiting relatives. Care documentation and other records were examined and aspects of care provision were observed. Staff members were spoken to and a shift handover observed. Progress made since the last inspection was reviewed. What the service does well: What has improved since the last inspection?
The rolling programme of decoration has continued with commendably prompt attention to any damage or defect. A burglary caused considerable damage to an office area, which required repair and refurbishment. Care assessments and daily recording of care provided have continued to develop. Staff training and staff supervision and appraisal have progressed well. China Cottage Nursing Home DS0000053683.V302580.R01.S.doc Version 5.2 Page 6 Recommendations from the last inspection have been addressed. The management of medication has been improved with checks each shift by the registered nurse on duty, and each day by the registered manager, that medication administered has been correctly signed off. The complaints documentation has been modified but there remains a need for a permanent log of complaints showing details of the date of the complaint, its content, actions taken to attempt resolution of the complaint, its outcome and details of the complainant’s level of satisfaction with the outcome. 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. China Cottage Nursing Home DS0000053683.V302580.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 China Cottage Nursing Home DS0000053683.V302580.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service and interviews with service users and relatives. Before admission was decided, the home’s senior staff carried out assessments and risk assessments which were clear about the care and support needs of prospective service users and whether they could be met by the home. EVIDENCE: Examination of a sample of care files showed that prospective service users had been assessed by the home’s senior staff together with the placing social workers. The assessments included all relevant aspects of care and support needs together with an assessment of risk the prospective service user’s status might pose. The evidence from assessment was then fed into the care planning process and daily activity programmes were created.
China Cottage Nursing Home DS0000053683.V302580.R01.S.doc Version 5.2 Page 9 Intermediate care is not provided at China Cottage. China Cottage Nursing Home DS0000053683.V302580.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 at least once during a 12 month period. 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. The records of medication administered have been reviewed and additional checks introduced to ensure service users’ safety. Care plans better reflect the documenting of care provided and its links to assessed needs. The home’s policies/procedures on medicines now protect service users. Staff treat service users with respect. EVIDENCE: Examination of a sample of care plans showed clear links between a service user’s assessed needs and actions and activities to be taken to meet those needs. The care plan and the daily recording of care provided was used at each shift handover to ensure that the service user’s needs were being met. There was regular review of care plans so that programmes to meet assessed needs could be amended as needs changed over time. China Cottage Nursing Home DS0000053683.V302580.R01.S.doc Version 5.2 Page 11 The recommendation from the last inspection about the recording of medication administered had been addressed. The registered nurse on each shift is now responsible for ensuring that medication administered has been properly signed off. The registered manager completes an overview check each day. Systems have been improved for recording instances when a service user refuses prescribed medication. There were clear procedures for the management of medication, which was securely stored in a locked room. Each service user’s Health Care Plan had a photo on the front cover to avoid possible mistakes, and Medication Administration Record sheets were securely contained. Service users spoken to said that they felt confident in the home’s management of medication. There were numerous examples observed of staff treating service users with dignity. Service users were addressed by their preferred name. Doors were knocked upon before entering and personal care and help was offered discreetly. At lunchtime staff attended quietly to those needing help. China Cottage Nursing Home DS0000053683.V302580.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 The home provides care, which is appreciated by the service users and their relatives. The pace of life in the home and its activities satisfies service users who praised the staff group and their care. Meals provided were balanced and appetising. Relatives were always welcome and were involved in care planning. EVIDENCE: Service users and their relatives spoken to said that visits are welcome any time and drinks/snacks are readily available. Relatives said they welcomed their inclusion in care planning and staffs’ prompt telephone discussion with them should there be a problem. There was good evidence of ready access for religious groups to hold worship in the home and of arrangements made to keep individual service users in touch with their Church. One service user said she was a ‘local girl in a local home’ and this linked to pride of the home’s involvement in the community and its activities. Particular links with the local pub and the local golf club were quoted. China Cottage Nursing Home DS0000053683.V302580.R01.S.doc Version 5.2 Page 13 In both the lounges and in their own rooms, some service users were reading while others watched television. Staff were observed spending time with service users looking at photographs or discussing the current news or TV programmes. Lunchtime was observed and the meal was balanced and appetising with alternatives/additional helpings available on request. Staff were observed helping discreetly but appropriately. Service users praised the variety and quality of food provided. A range of activities was set out on a programme on the homes’ foyer – a craft ‘workshop’ was in progress during the inspection with service users working with paint and soft fabrics. During the day professional entertainers held a sing-song in one of the lounges. Service users spoken to said that they were free to join in or not and could suggest activities for inclusion in the programme. They said that the home suited them in that ‘nothing was too much trouble’ for staff and it was ‘a home from home’. One relative said that she had persevered in getting her sister moved from one home into China Cottage where she was happy and settled. All those spoken to were full of praise for the staff group and for the care offered. China Cottage Nursing Home DS0000053683.V302580.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users and relatives were confident that their concerns or complaints are listened to and addressed. There remain shortfalls in the recording of complaints and their attempted resolution, which must be remedied. Staff training supports the home’s procedures on adult protection so as to protect service users from abuse. EVIDENCE: Service users and relatives spoken to were confident that if they had a grievance they could speak to staff and the matter would be quickly addressed. There was less certainty in knowledge about formal complaint processes. That is to be addressed by service users’ keyworkers. From the last inspection a recommendation had been made that the recording of complaints should be possible in confidence and that action taken about complaints should be better recorded. The registered manager has been unable to address this in full because amendments to company procedures have to be ratified by the company and then introduced consistently in the company’s other homes. China Cottage Nursing Home DS0000053683.V302580.R01.S.doc Version 5.2 Page 15 A model for a permanent complaints log, which recorded full detail of the complaint and of action taken to attempt its resolution, together with the complaint’s outcome and information about the complainant’s response, was discussed with the registered manager. There had been no complaint logged since the last inspection. The home had clear procedures for protecting service users from abuse, which were supported by staff training. An earlier complaint resolution which involved the protection of several service users demonstrated how staff put the procedures into effect. China Cottage Nursing Home DS0000053683.V302580.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 at least once during a 12 month period. 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 live in a well-maintained homely environment. EVIDENCE: The home is well decorated with a rolling programme of re-decoration. The staff group includes a handyman who maintains the premises and gardens to a good standard. Any damage is quickly rectified and service users spoke highly of his help with shelving, handrails and other repairs required which are attended to promptly. . There is easy access to the ground floor lounges and dining room accommodation. The rear gardens are sheltered and private and provide a good extension to the ground floor accommodation. China Cottage Nursing Home DS0000053683.V302580.R01.S.doc Version 5.2 Page 17 Service users’ had personal possessions, photographs and furniture in their rooms. Whenever possible, they could choose fabrics and colour schemes when their rooms were re-decorated. Safety in the home had received considerable attention. There was good provision of grabrails and handrails. Hoists and lifting equipment were in evidence. The home was clean and there was no offensive odour. Domestic staff spoken to said that they had sufficient equipment and material to keep the home clean China Cottage Nursing Home DS0000053683.V302580.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 at least once during a 12 month period. 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 including discussions with staff members. There is an ongoing training programme for staff which, together with supervision and appraisal system, ensures that they are equipped to provide as good a standard of care as is possible. Service users are protected by staff recruitment policy and practices. EVIDENCE: Staff spoken to said that they received training on various care-related topics to help improve the standard of care on offer to the service users. Since the last inspection this had included fire training, first aid, continence management and podiatry. In addition, the registered manager had continued with the Registered Manager’s Care Award and there were plans for the deputy manager to start the same course. From the last inspection there had been a Statutory Requirement that first aid training should be provided to all staff who had not undertaken such training. There was evidence that first aid training had been provided but there was less certainty about the need to comply with Health and Safety Regulation about the need for first aid trained staff to be available despite a Registered General Nurse being part of every shift.
China Cottage Nursing Home DS0000053683.V302580.R01.S.doc Version 5.2 Page 19 Examination of personnel files showed evidence of a recruitment and interview process, of references taken up before employment commenced, and of Criminal Record Bureau checks completed. There was a process in place for CRB checks to be renewed as necessary. China Cottage Nursing Home DS0000053683.V302580.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 at least once during a 12 month period. 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. Adult protection, health, complaint and financial safeguards protected the interests of service users. Appropriate staff employment, supervision, appraisal and training processes in place promoted staff interests. EVIDENCE: Service users spoken to said that they felt safe in the home and that staff protected them and looked after their best interests. Service users and relatives spoken to said they were confident that they could raise issues with staff and that they would be addressed. Further development of the complaints procedure and its recording will further safeguard service users’ right to complain in confidence.
China Cottage Nursing Home DS0000053683.V302580.R01.S.doc Version 5.2 Page 21 Staff supervision and appraisal offered staff the assurance that their interests and prospects were being safeguarded while training about risks to their health such as Lifting and Handling procedures protected their employment. Supervision was programmed to shift patterns and was recorded on a document signed by both supervisor and supervisee. Actions required and targets identified through supervision were fed into the staff appraisal process. There was evidence of good links between the registered manager and company staff from whom she received regular supervision. The home managed the personal allowances of a small number of service users. A sample check of service users’ accounts showed that income and expenditure was recorded and any transaction carried two staff signatures together with the appropriate receipts. Monies held tallied with records. The registered manager audited all accounts on a monthly basis with an available record of findings. China Cottage Nursing Home DS0000053683.V302580.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 3 X X X X X X 3 Standard No 7 8 9 10 11 Score 3 3 3 3 X STAFFING Standard No Score 27 3 28 2 29 3 30 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 China Cottage Nursing Home DS0000053683.V302580.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 OP16 Regulation 12, 22 Requirement The home should provide a permanent log of complaints which sets out details of the date a complaint is received, the complainant, the complaint, action taken to resolve the complaint and by whom, the complaint’s outcome, the complainant’s level of satisfaction with the outcome and further action taken if needed. The home should ensure that first aid trained staff are available on each shift Timescale for action 30/11/06 2 OP38 13 31/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations China Cottage Nursing Home DS0000053683.V302580.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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