Inspection on 06/05/08 for Clover Cottage

This inspection was carried out on 6th May 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Clover Cottage 22/06/07

Clover Cottage 06/07/06

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Clover Cottage 44 Wincanton Road Noak Hill Romford Essex RM3 9DH Lead Inspector Jackie Date Unannounced Inspection 6th May 2008 10:00 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 Clover Cottage DS0000066722.V363915.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. Clover Cottage DS0000066722.V363915.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clover Cottage Address 44 Wincanton Road Noak Hill Romford Essex RM3 9DH 01708 342 038 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) clovercottage07@yahoo.co.uk Mrs Santosh Magon Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Clover Cottage DS0000066722.V363915.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 14 22nd June 2007 Date of last inspection Brief Description of the Service: Clover Cottage is a care home providing care to 14 older people who do not require nursing care. The home consists of two storeys and is located in a residential area of Noak Hill within the London Borough of Havering. There are ten single bedrooms and two shared bedrooms, four of which have an en suite. All other bedrooms have a hand basin, TV point and a call system. There is a passenger lift and also a stair lift. The communal areas are situated on the ground floor and this is open plan with a small room divider making two lounge areas and a dining area. From this open plan area is a conservatory that is also used as a dining area. There is car parking and a garden to the front of the building, and a well maintained rear garden with disabled access from the conservatory. The home is situated close to local facilities in Noak Hill and is accessible by buses and by car from the M25, A127 and the A12. The charge per week for each person is between £404 & £501. The manager provided this information on the day of the visit. Information about the service provided is contained in the service users guide. Clover Cottage DS0000066722.V363915.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 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was unannounced and started at 10 am. It took place over seven and a half hours. This was a key inspection and all of the key inspection standards were tested. Staff were asked about the care that people using the service receive, and were also observed carrying out their duties. Where possible people using the service were asked to give their views on the service and their experience of living in the home. All of the shared areas and some bedrooms were seen. Staff, care and other records were checked. Relatives, social workers and healthcare professionals were contacted and asked for their opinions of the service. At the time of writing this report feedback had been received from 2 relatives and the Local Authority. In addition feedback surveys were also received from 1 staff and 8 people living at Clover Cottage. Any feedback subsequently received will be taken into account for future inspections. The last key inspection was in June 2007. In November 2007 a shorter random unannounced inspection was carried out. The purpose of this was to monitor the actions to address the requirements made at the time of that previous visit. Where appropriate references are made about this inspection in relevant sections of this report. The manager in post at the time of this inspection has now retired and the new manager has been in post since February 2008. Services are now required to complete an AQAA (Annual Quality Assurance Assessment) and the completed form was received in April 2008. At the time of completing the AQAA the manager had only been in post for a very short while and was only able to provide limited information about the service. Information provided in this document also formed part of the overall inspection. The inspector would like to thank the people living at Clover Cottage and the staff for their input during the inspection. What the service does well: A relative said, “it gives me and mum’s family peace of mind to know she is well cared for and treated well”. Clover Cottage DS0000066722.V363915.R01.S.doc Version 5.2 Page 6 Another relative said, “I am happy with the care, the manager is the best so far. My mother says that she is happy and wants to live here”. People living at the home said, “staff are nice”, “the food is good”, “the manager listens to you”. There has been a regular staff team and people are receiving support from staff that they know. The new manager and the staff team have been working together to raise standards at the home and people living there and their relatives are happy with the care provided. What has improved since the last inspection? What they could do better: Although the administration of medication is better than at the time of the last inspection there are still requirements in this area. Two of these are repeated from the previous random inspection in November 2007 and the timescale for Clover Cottage DS0000066722.V363915.R01.S.doc Version 5.2 Page 7 meeting these has been extended to allow the new manager to address them fully. These must be addressed as they have an impact on the welfare of people living at the home. Failure to meet these may result in the Commission taking enforcement action. The proprietor has carried out a lot of improvements to the environment but the bathing facilities still need to be improved to make them suitable for people living there to use if they wish to. This will also give them a real choice between having a bath or a shower. 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. Clover Cottage DS0000066722.V363915.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Clover Cottage DS0000066722.V363915.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 & 5. Standard 6 does not apply to this home. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Information is obtained to enable the staff team to decide whether or not the home can meet a persons needs. People thinking of moving into the home and their relatives can spend time in the home to find out what it would be like to live there and to enable the person to make a choice about living in the home, within their capacity to do so, and to be confident that the home meets their needs. The home does not offer intermediate care. EVIDENCE: Referrals are usually received from Social Services department and they provide initial assessment information. This may be from information that they have gathered or from assessments made by hospital staff. The manager then carries out assessments before an individual moves into the home. At this Clover Cottage DS0000066722.V363915.R01.S.doc Version 5.2 Page 10 time people are provided with information about the home and encouraged to visit. The assessments cover all of the required areas and include health, mobility, nutrition, continence and religious and cultural needs. Examples of this were seen in files. From this assessment information an initial basic care plan is drawn up to enable staff to provide appropriate care for an individual when they move into the home. Individual records are kept for each person and three files were examined. These included pre-admission assessments that had been carried out by the manager. There was also assessment information from social services. There have not been any new admissions since the current manager started work at the home. From the paperwork and discussions with the manager we were satisfied that appropriate assessments would be carried out and that the necessary information gathered before a decision is made as to whether the service could support an individual. The new manager said that he had been unable to find any contracts at the service. Feedback from people using the service was that some said they had received contracts and others that they had not. One person said they had not received a contract but that they will receive it next month. New contracts are being drafted and should be issued in the next couple of weeks. Therefore a requirement has not been made but this will be monitored during future visits. Once new contracts have been issued it will mean that people using the service and their relatives will have a clear idea as to what services they will receive. The home does not provide intermediate care. Clover Cottage DS0000066722.V363915.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. People using the service experience adequate quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. People’s needs are identified and staff have information about how to meet these. They receive personal and healthcare care that meets their individual needs and preferences. The principles of respect, dignity and privacy are put into practice. Ongoing developments and updates to care plans will make this process more person centred and consistent. The administration of medication is not robust enough to ensure that people receive their prescribed medication correctly and safely. EVIDENCE: At the time of the random inspection in November 2007 each person living at the home had a plan, which covered the necessary areas and these gave information about each person’s needs and preferences. A random sample of care plans were checked at the time of that visit. These contained far more detail than at the time of the key inspection in June 2007. They were up to Clover Cottage DS0000066722.V363915.R01.S.doc Version 5.2 Page 12 date and had been reviewed monthly. Since the new manager started work at the home care plans are being reviewed and updated in a different format. He is in the process of doing new assessments to get a current picture of each persons needs. The new care plans will include life pictures. This work has not been completed yet and therefore plans are at different stages. However each person does now have a night care plan and those seen contained up to date information in that area. The night care plans seen were tailored to each individual. One plan said that the person did not like a drink before they went to bed, preferred the light off and liked tea in bed in the morning. Another said that the person liked a hot drink of Horlicks before they went to bed. This is a small home and people living there are supported by a regular staff team that know how they like to be supported and this information can be fed into the new care plans. This is an area of ongoing development and at this stage a requirement is not needed as the staff team is undertaking this work. There are risk assessments in place. These identify risks for people and indicate ways in which the risks can be reduced to enable their needs to be met as safely as possible. These were relevant to each person and included moving and handling and when necessary prevention of pressure sores for people identified as at risk of this. These had been reviewed and were up to date. Some people living at the home require a lot of help with personal care but others spoken to said that they can manage most of this on their own. They said that they were allowed time to do this and were not rushed. They also said that the staff were nice and that one staff sometimes “does their nails”, which they obviously appreciated. This was referring to their varnished nails. All of the people living at Clover Cottage are registered with a local doctor and specialist help is received when needed. Records are kept of medical appointments and these show that people have checks from the optician, dentist and when needed the chiropodist. Staff were observed to be polite and respectful to the people using the service and were observed to knock on doors before entering peoples’ rooms or bathrooms. People spoken to confirmed that staff respected their privacy and dignity. At the time of the last key inspection a CSCI pharmacy inspector also carried out an inspection. At the time of the random inspection all but one of the requirements from that visit had been addressed but there were three new requirements in relation to medication administration. The home does not have a dedicated medicines fridge and medicines requiring refrigeration are stored in a locked box in one of the fridges in the kitchen. A maximum/minimum thermometer is now used to provide details of the temperature range. This ensures that medicines are kept within the correct temperature range (2-8 degrees C.) to maintain their therapeutic action. This Clover Cottage DS0000066722.V363915.R01.S.doc Version 5.2 Page 13 was the outstanding requirement from the key inspection. With the exception of Controlled Drugs medication is stored in an appropriate metal trolley that is attached by a chain to the wall in the dining/conservatory area. Where possible medication is administered via a monitored dosage system. Medication is administered by staff that have received appropriate training and there is a list of staff that can administer medication along with their initials. The medication file contained profiles of each person and in most cases a photograph. This is good practice. Examination of the MAR (Medication Administration Record) found that this was not always being correctly maintained. When the directions for giving a medicine allow a choice of dosage, for example 1 or 2 tablets, the number given was not always being recorded. Without this record it is not possible to check if medicines have been given correctly. Therefore this must be done. On occasions the code “O” was used. When using this undefined code the reason for the omission was not always being recorded to give feedback on the treatment. This also must be done. For another person it appeared that someone had added an extra dose of simple linctus during the day but there was no information recorded as to who agreed this and why. The instructions for some medication was “when required” but people were being given this everyday in line with their medication profile. The MAR chart must accurately reflect the dosage and frequency of the medication that a person is prescribed. Any discrepancies must be addressed with the prescriber and/or the dispensing pharmacist. If necessary changes must be made to the chart. This is important to ensure that people get their prescribed medication appropriately and as safely as possible. Some people are prescribed CD (Controlled Drugs); these are stored in a locked cupboard in the office. However a dedicated CD cupboard that meets with the requirements of the Misuse of Drugs Regulations 1973 is required. The new manager was not aware that the cupboard was not suitable and believed that the one in use had been fitted in response to the previous requirement. In addition the legislation with regard to the storage of CD’s in care homes has only changed this year. Therefore the timescale for this previous requirement has been extended to allow him to address this. Some other medication was also stored in this cupboard and this is not appropriate. When used to store CDs then the cupboard is to be used solely for that purpose and only contain CDs. The present CD cupboard is situated on a wall within reach of and view of a window. The new cupboard may need to be fitted in a different place to offer more security. It is recommended that the manager seek advice on this from the local crime prevention officer. The manager has obtained an appropriate CD register and this is in use. Two people sign entries and the CD’s are counted and checked. This is good practice. We counted the CD’s and the amount held agreed with the register. Clover Cottage DS0000066722.V363915.R01.S.doc Version 5.2 Page 14 Some people receive PRN (when required) medication and protocols/guidelines have been developed for some of these to ensure that all staff knows when to give this medication and for what purpose. The timescale for meeting this requirement has been extended to allow for the remaining protocols to be put in place. Overall the administration of medication has improved but is still not robust enough and this needs to be addressed to ensure that people receive their correct prescribed medication as safely as possible and that the risk of errors are minimised as far as possible. There are two requirements outstanding from the previous inspection and these must be addressed as they impact on the welfare of people using the service. Failure to meet these requirements by the required timescale may result in the Commission taking enforcement action to secure compliance. Clover Cottage DS0000066722.V363915.R01.S.doc Version 5.2 Page 15 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 using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. People are able to make informed choices about what they do and how they spend their time but activities need to be developed further to ensure that people have as interesting and stimulating lifestyle as possible. As far as possible, people are helped to exercise choice and control over their lives. Visitors are made welcome at the home and are invited to social events. Therefore people are able to maintain contact with their friends and families. People receive good quality meals that meet their preferences and needs. EVIDENCE: We were able to talk with several people during the inspection, and all said that they were very happy at the home. From discussions with the new manager, staff and people using the service it was apparent that they have discussed activities both in the home and in the community and that they are Clover Cottage DS0000066722.V363915.R01.S.doc Version 5.2 Page 16 trying to develop these. One person said, “Michael (the manager) said he would try to get us out and to do some exercises”. Some games and craft items are available and the activity file records exercise, karaoke and bingo. It is planned that one of the people using the service does a trolley shop twice a week so that people can buy small items. The new manager has held a residents’ meeting and asked people what they would like to do. This was also the situation at the time of the last key inspection and the development of activities has been slow. A relative said, “people could go out more”. However improved staffing levels in the mornings should mean more staff availability to support activities or people going out and the manager is aware that this is an area for going development and as he is working on this no requirement has been made at this stage. A hairdresser visits the home weekly and people look forward to this as they like having their hair set and view this as a social occasion. At the time of the last key inspection there was evidence that the quality of the food had continued to improve. Since the new manager has been in post the menu has changed, in consultation with people using the service. Fresh vegetables, fruit and meat are obtained from local suppliers and are delivered to the home. There is now routinely a second choice and at this time of year is salad, which people using the service like. There were ample supplies of food in fridges, freezers and the store cupboards. People using the service said that the food was good and you can always have something different. They also said that they liked the changes that had been made at breakfast. Instead of breakfast being at a set time it is now served between 7.30 and about 9am. People using the service said, “staff give early people breakfast and the rest of us have it when we come down”. We joined people at lunch time and meals were well presented and the dining tables nicely laid. People were offered cold drinks with their meal and tea or coffee afterwards. One person had a beer with his lunch. Another person is unable to eat without support from staff and we observed that her food was softened and that a member of staff sat with her, encouraging her to eat and drink. She was given plenty of time to do this and was not rushed or hurried. At present none of the people using the service have any specific dietary requirements in relation to their cultural or religious needs. Drinks are available throughout the day and people said that they have tea in bed. Religious services are held at the home on a monthly basis and this meets the needs of people currently living there. Church was discussed at a residents meeting but people said that they were not interested in this. They did however ask if they could have an alcoholic drink with Sunday lunch and this has been organised. Relatives can visit at any time, as there are no restrictions placed on visiting times. People can spend time with their visitors in the lounge, conservatory, garden or in their own rooms. Some people said that they had relatives that Clover Cottage DS0000066722.V363915.R01.S.doc Version 5.2 Page 17 visited regularly and that they were made welcome and offered refreshments. Relatives are invited to any celebrations. People living at the home said that they always celebrate birthdays and have a birthday cake. People using the service also confirmed that they are asked what they want or what they would like and that they can then make a choice about this. Clover Cottage DS0000066722.V363915.R01.S.doc Version 5.2 Page 18 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 using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. There is a complaints procedure that is followed in the event of any complaints being made. People feel able to complain and feel that the manager will listen to their concerns. Staff have had safeguarding adults training to ensure that they are clear about what constitutes abuse and what to do if abuse is seen or suspected. The systems in place to safeguard people are more robust than at the time of the last inspection. This gives people living at the home a greater protection from abuse. EVIDENCE: The home does have a complaints procedure that is used in the event of a complaint being made. There have not been any complaints since the new manager has been in post. There were recorded complaints that were addressed by the previous manager. Whilst most were satisfactorily addressed one should have been referred as a possible safeguarding issue rather than addressed as a complaint. From talking to the people living at the home it was evident that the manager often asks them if everything is okay and that they can talk to him. One person said, “he listens to you. We need to ask for things”. The Commission has received two anonymous complaints since the last inspection and the proprietor addressed these. Feedback from the Local Authority was that they did not appear to have Clover Cottage DS0000066722.V363915.R01.S.doc Version 5.2 Page 19 received any problems or complaints about the service since the last inspection. The home has policies and procedures for safeguarding people from abuse. Staff have received training in the detection and reporting of abuse At the time of this inspection we were focussing on safeguarding issues and the manager, three staff and three people using the service were asked specific questions about this. People using the service said, “I have never thought about it”, “staff will help us if we need it”; “we could tell staff or Michael (the manager), we would not be frightened to”. In discussions with staff they were clear what forms abuse took and said what they would do if any suspected abuse was witnessed. Staff also said that the training that they had covered whistleblowing. The manager was also clear about what forms abuse takes and was clear that he would have dealt with the complaint mentioned early inline with safeguarding. At the time of writing this report he had been made aware of a possible safeguarding issue and he had taken the appropriate initial action. We will be monitoring the outcome of this and will take any necessary action as a result of this. The home does not deal with peoples’ overall finances, but some people have small cash amounts held in safekeeping and only the manager has access to this. The section on management and administration gives more details on this. Some people keep their own cash and there are now lockable facilities in each bedroom so that people can safely keep their own money and valuables if they wish to. This combined with the improved management of peoples’ cash offers better safeguards from financial abuse. Clover Cottage DS0000066722.V363915.R01.S.doc Version 5.2 Page 20 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, 20, 21, 22, 23, 24, 25 & 26. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. People live in a clean and comfortable home and the proprietor continues to work to improve the environment. The bathing facilities need to be upgraded to ensure that they are suitable for people living in the home and that they are of a satisfactory standard. EVIDENCE: The home has two storeys and is located in a residential area of Noak Hill within the London Borough of Havering. There are ten single bedrooms and two shared bedrooms, four of which have an en suite. All other bedrooms have a hand basin, TV point and a call system. There is a passenger lift and also a stair lift. The communal areas are situated on the ground floor and this is open plan with a small room divider making two lounge areas and a dining area. From this open plan area is a conservatory that is also used as a dining Clover Cottage DS0000066722.V363915.R01.S.doc Version 5.2 Page 21 area. There is car parking and a garden to the front of the building, and a well maintained rear garden with disabled access from the conservatory. The home is situated close to local facilities in Noak Hill and is accessible by buses and by car from the M25, A127 and the A12. A tour of the care home indicated that the premises are clean, hygienic and well maintained, with no offensive odours. Since the last inspection a new cleaning schedule has been introduced. A relative said the home is cleaner and tidier now. The manager has purchased appropriate bags for washing any soiled laundry and hand towels have been replaced by paper towels. This is good practice in terms of infection control. All areas were appropriately furnished and had a homely appearance. All bedrooms were individually decorated and lots of personal possessions were on display making the rooms look homely. Some bedrooms have been refurbished and it is planned that any commodes will be replaced in the near future. New pictures and some new dining furniture are in the lounge & dining area and it is now less cluttered and there is more room. The garden areas were attractive with seating areas and it was apparent that these are regularly maintained. A handyman is employed and any repairs and maintenance are therefore dealt with in a timely fashion. There were sufficient bathrooms/shower and toilets for the number of people living at the home and those toilets viewed were equipped with hand washing facilities, soap and towels. The bathroom on the ground floor contains a corner bath that is not suitable for use by people living in the home. It is also in poor condition. This bathroom needs to be refurbished and to have suitable facilities fitted. There is also a bathroom upstairs with a bath chair. However this does not work. The manager said that most people prefer showers and the one person that bathes can use the bath without using the bath chair. Therefore in reality most people living at Clover Cottage do not have a choice between a bath and a shower and the bath chair must be in good working order. The home has purchased some moving and handling aids and a hoist has been ordered and was due to be delivered in the very near future. This will ensure that suitable moving and handling aids are available to assist in safely moving people using the service. There are laundry facilities available so that peoples’ clothing, bedding etc can be washed appropriately. A sluice sink has been fitted for soiled laundry and the handyman has started to paint the laundry. The washing machine is of domestic design and needs to be upgraded and to include a sluice facility. At the time of the random inspection in November 2007 we were informed that the washing machine and tumble dryer would be upgraded once other refurbishment had been completed. Clover Cottage DS0000066722.V363915.R01.S.doc Version 5.2 Page 22 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 using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. People using this service are supported by a staff team that have the necessary skills and training to provide service to meet their needs. Staffing levels are sufficient to allow staff time to use their skills and experience to meet peoples needs. The recruitment process is now more robust and offers better safeguards for the people using the service. EVIDENCE: The usual staffing compliment is now 3 staff during the early shift and 2 during the late shift. One of these staff is normally a senior carer. At night there are 2 waking staff. In addition there is a part time cook and some domestic support. When the cook is not on duty care staff do the cooking as an additional shift. The staffing levels for the early shift have been increased and feedback from staff was that this is much better as mornings are the busiest time and it also gives scope for activities. The staff team also said that the manager is very “hands on” and will work with staff on various tasks. From checking the rota, talking to staff and observations during the visit the current staffing arrangements are sufficient to meet the needs of the people living Clover Cottage DS0000066722.V363915.R01.S.doc Version 5.2 Page 23 there and 3 staff on duty during the early shift should continue. Feedback from people living at the home was that the staff were nice. They also said that there had been some problems with the night staff but this had been sorted out and things were okay now. The manager said that staff come in 15 minutes before the start of their shift for a handover. He also said that they were paid for this. However this is not shown on the rota. It is recommended that the rota be changed to show the exact times that staff are working and that this includes any handover period. This will give a clear record of when people are working and provide confirmation that handovers are built in to allow for sharing of information. From discussions with the manager and staff and from checking staff records it was evident that most staff have experience of caring for older people. At the time of the random inspection in November 2007 feedback from staff was that they had had a lot of training. This included medication, moving and handling, Protection of Vulnerable Adults and the Mental Capacity Act. Infection control and first aid training had also been arranged. Staff have also had some training on working with people with dementia to assist them when working with some of the people who are confused. One member of staff confirmed that she was doing a dementia training course through a local college. The new manager has continued to arrange training and has also provided in house training. For example fire safety training was arranged and care planning, Protection of Vulnerable Adults and COSHH (Care of Substances Hazardous to Health) training had already taken place. The AQAA (Annual Quality Assurance Assessment) said that three staff have completed NVQ level 2. In addition some staff are doing NVQ level 3. A selection of staff files were examined and this included the file of a new employee who was doing her induction while waiting for her CRB (Criminal Records Bureau) check. Files seen contained a copy of the application form, references, confirmation of identity, CRB (Criminal Records Bureau) check and other required details. For the person doing her induction there was evidence that a POVA (Protection of Vulnerable Adults) check had been carried out before she started. The manager said that this person would not start full duties until the CRB had been received. This is good recruitment practice. Observations at the time of the inspections was that staff were patient and kind to people living in Clover Cottage and there was a calm relaxed atmosphere. Clover Cottage DS0000066722.V363915.R01.S.doc Version 5.2 Page 24 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, 32, 33, 35, 36, 37 & 38. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. The manager has started to implemented changes for the benefit of people using the service. The home is being appropriately managed by an experienced manager and a safe environment is being maintained. EVIDENCE: At the time of the inspection the new manager had been in post for almost 3 months. The manager has a lot of experience of managing services for older people and has previously been a registered manager at other services. He has an NVQ in care and has also completed the RMA (Registered Managers Award). Feedback from a relative whose mother has lived at the home for a few years was “he is the best manager so far and the home is cleaner and tidier”. People living at the home said, “Michael (the manager) is good, he Clover Cottage DS0000066722.V363915.R01.S.doc Version 5.2 Page 25 listens to you and we have had a meeting”. The feedback from staff was “the manager is definitely supportive, hands-on and a very calming influence”. “Staff are much happier and this benefits the people living at the home”. Staff also said that the manager set tasks and deadlines and that standards have gone up”. The quality of the service is monitored by the manager and by the proprietor. The manager said he has visited the service during the weekends to check that everything is running smoothly and appropriately. People living in the service were given a quality assurance questionnaire in April to get their feedback about the service provided. The issues raised were then discussed at a residents meeting. The proprietor carries out monthly monitoring visits and writes a short report as a result of that. Copies of these reports were seen in the home. The format of the report has changed at the instigation of the new manager. The proprietor does not have a background in care and it is recommended that the monitoring visits be made by a person with experience of care and of good practice in services for older people. This will ensure that the service is more robustly monitored and that any area that did not meet minimum requirements is identified. Staff spoken to said that they had been receiving supervision and that staff meetings were being held. This gives staff the opportunity both collectively and individually to discuss work practice, any concerns and the development of the service. However, the manager does not receive any professional supervision and is important that this does happen to support the manager in his own development and the development of the service. It is therefore recommended that the proprietors make arrangements for the professional supervision of the manager. The manager does not deal with peoples’ overall finances, but for some has small cash amounts in safekeeping. This cash is used on their behalf for purchases or services from the chiropodist and hairdresser. The cash held for three people was checked and amounts recorded tallied with cash held. All entries were recorded and receipts were kept to evidence any expenditure. Each person’s cash is now kept separately with an individual record as required by the previous inspection. Therefore peoples’ finances are appropriately dealt with. With the exception of confidential information all of the records have been moved to the office in the main part of the home and are therefore available for inspection at any time and are also more easily accessible for staff. The staff team carries all of the necessary health and safety checks out regularly. For example fire call points are tested weekly to ensure that they are working correctly. There was a short period when this was not carried out due to the key being misplaced but the new key is now available. Hot water temperatures are tested monthly but in line with best practice it is Clover Cottage DS0000066722.V363915.R01.S.doc Version 5.2 Page 26 recommended that this be carried out each week to offer more robust safeguards for people living at home. Fridge and freezer temperatures are tested daily and appropriate servicing is carried out on the fire system and fire equipment. A safe environment is maintained. Clover Cottage DS0000066722.V363915.R01.S.doc Version 5.2 Page 27 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 2 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 3 2 3 3 3 3 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 3 3 X 3 3 3 3 Clover Cottage DS0000066722.V363915.R01.S.doc Version 5.2 Page 28 YES Are there any outstanding requirements from the last inspection? 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 Requirement Individual protocols/guidelines are needed to ensure that all staff know when and why to administer PRN medication to each individual. (Previous timescale of 31/01/08 not fully met) A dedicated controlled drug cupboard that meets with the requirements of the Misuse of Drugs Regulations 1973 is required. . (Previous timescale of 31/01/08 not fully met) To comply with legislation when used to store CDs the cupboard must be used solely for that purpose and only contain CDs. When the code “O” is used on the MAR (Medication Administration Record) the reason for the dosage not be given must be recorded on the chart. This is to give a clear record of why medication has not been given and also to assess the medicine’s therapeutic effect. The MAR chart must accurately reflect the dosage and frequency DS0000066722.V363915.R01.S.doc Timescale for action 30/06/08 2. OP9 13 31/08/08 3. OP9 13 30/06/08 4. OP9 13 30/06/08 5. OP9 13 30/06/08 Clover Cottage Version 5.2 Page 29 6. OP21 23 7. OP21 23 of the medication that a person is prescribed. Any discrepancies must be addressed with the prescriber and/or the dispensing pharmacist. If necessary changes must be made to the chart. This is important to ensure that people get their prescribed medication appropriately and as safely as possible. The bath chair fitted in the 30/06/08 upstairs bathroom must be repaired and in good working order so that people living at the home can use this facility safely and can have a choice to bath or shower. The ground floor bathroom must 31/12/08 be refurbished and include facilities suitable for the needs of people living at the home. This will ensure that they are able to easily and safely use the facilities and will have a choice of bathing or showering. 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. 2. 3. Refer to Standard OP9 OP26 OP27 Good Practice Recommendations It is recommended that the local crime prevention officer be consulted on the location of the CD (Controlled Drug) so that this is as secure as possible. It is recommended that an industrial washing machine be installed to ensure that laundry is appropriately washed. It is recommended that the rota be changed to show the exact times that staff are working and this includes any handover period. This will give a clear record of when people are working and provide confirmation that handovers are built in to allow for sharing of information. DS0000066722.V363915.R01.S.doc Version 5.2 Page 30 Clover Cottage 4. OP33 5. OP36 6 OP38 It is recommended that the monitoring visits be made by a person with experience of care and of good practice in services for older people. This will ensure that the service is more robustly monitored and that any area that did not meet minimum requirements is identified. It is recommended that the proprietor makes arrangements for the professional supervision of the manager. This will ensure that the manager has the opportunity to discuss their own development and the development of the service. It is recommended that hot water temperatures be tested on a weekly basis to ensure that they do not exceed the prescribed safe temperature. This lessens the risk of scalding. Clover Cottage DS0000066722.V363915.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Clover Cottage DS0000066722.V363915.R01.S.doc Version 5.2 Page 32 - 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. 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