CARE HOMES FOR OLDER PEOPLE
Cobgates Falkner Road Farnham Surrey GU9 7UG Lead Inspector
Helen Dickens Announced 28 July 2005 09:30 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 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. Cobgates H58 S33558 Cobgates V226349 280705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Cobgates Address Falkner Road Farnham Surrey GU9 7UG 01252 714834 01252 734256 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) SW Surrey Adults & Community Care Services, Grosvenor House, London Sq, Cross Lanes, Guildford, Sy, GU1 1FA Mrs Gaye Munton Care Home (CRH) 50 Category(ies) of Old age, not falling within any other category registration, with number (OP) 50 of places Physical disability over 65 years of age (PD(E)) 50 Sensory Impairment over 65 years of age (SI(E)) 50 Mental Disorder, excluding learning disability or dementia - over 65 years of age 1 Cobgates H58 S33558 Cobgates V226349 280705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1 Accommodation and Services may be provided to named persons aged 60 - 65 years with the prior written agreement of the CSCI. 2 Respite Care may be provided to a maximum of 5 persons at any one time. 3 Accomodation and services may be provided for a named service user with mental disorder with the prior written agreement of the CSCI. Date of last inspection January 2005 Brief Description of the Service: Cobgates is a two-storey residential care home designed to accommodate older people. It is managed by Surrey County Council. The home is very near Farnham town centre and has easy access to all facilities. The home is in its own grounds with garden areas and ample parking. The home is very well presented and offers a good standard of accommodation for up to 50 residents over the age of 65. All bedrooms are single occupancy. The home has seven separate units, each with its own sitting/dining area and kitchenette. All parts of the home are accessible to residents. Cobgates H58 S33558 Cobgates V226349 280705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took place over seven hours and was the first inspection to be undertaken in the Commission for Social Care Inspection year April 2005 to March 2006 The inspection was carried out by Mrs. Helen Dickens, Lead Inspector for the service. Mrs. Gaye Munton, the Registered Manager, represented the establishment. A full tour of the premises took place. Six residents and two staff were spoken to at length, and an additional number conversed with during the inspection. A pre-inspection questionnaire and returned ‘comment cards’ were used in writing this report. In addition, the inspector sampled a number of documents and records on the day of the inspection. All comments quoted in the main body of the report are reproduced only with permission. What the service does well:
The service offers a pleasant and very homely environment for its elderly residents. The standard of furnishings and decoration is very good and the home is clean and odour free throughout. The residents all spoke well of the home and its staff; both in their written comments in advance of the inspection, and on the day, residents were complimentary. Comments such as ‘People are very kind’ and ‘I love it here’ were typical. After explaining to one resident the point of the ‘unannounced’ inspection which would be happening later in the year, the resident said ‘You would always find it alright here.’ On a temporary basis, Cobgates is accommodating seven residents from another Surrey County Council home currently undergoing repair. These people, together with two first-time respite care residents, had all formed a very positive impression about the home during their stay. The food came in for particular praise from residents, one resident said she had put on two stones since she moved in. The lunch sampled on the day of the inspection was both tasty and nutritious and residents commented on how much they had enjoyed it. Staff interacted well with residents and were observed to be respectful towards them. They worked well as a team and there was a professional yet friendly atmosphere in the home.
Cobgates H58 S33558 Cobgates V226349 280705 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cobgates H58 S33558 Cobgates V226349 280705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Cobgates H58 S33558 Cobgates V226349 280705 Stage 4.doc Version 1.40 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 standard(s) 3 and 4 Prospective residents can be confident that the systems in place will correctly identify and meet their needs. EVIDENCE: Resident’s files showed that assessments had been professionally carried out by Care Managers prior to admission. Care plans were then drawn up according to the Care Manager’s and the home’s ongoing assessments and reviews. On the day of the inspection the home demonstrated its capacity to meet existing residents needs. Residents confirmed they were well looked after and happy at Cobgates. The home has also prepared well for the arrival of their new client group, older people with dementia, and specialist advice has been sought and acted upon in this regard. Cobgates H58 S33558 Cobgates V226349 280705 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 Residents needs and preferences have been identified and these have been taken into account by the staff at Cobgates. EVIDENCE: The health personal and social care needs of residents are identified in their care plans. However, the home is currently up-dating all resident’s plans and this exercise needs to be completed as soon as possible. Advice has been taken from other professionals where appropriate, for example with regard to falls. A falls audit has resulted in a special referral procedure for those residents at risk of falling. The comment cards received from professionals who deal with this home were very positive. However, one suggested there might be better communication with the home. This issue was highlighted with the Registered Manager who will try and ensure there is good communication with visiting professionals at all times. The inspector felt there was an over provision of incontinence aids in some parts of the home and recommended that only residents assessed as needing such aids should have these placed on their chairs. The medication administration policy review was a requirement from the last inspection and this has been carried out with advice from another Surrey County Council home, as recommended by the previous inspector. However,
Cobgates H58 S33558 Cobgates V226349 280705 Stage 4.doc Version 1.40 Page 10 though the number of errors have reduced, there is still room for further improvement. The Registered Manager needs to follow up on the promised pharmacy training for staff in order to meet this standard fully. The inspector observed residents being treated with respect and their wishes taken into account and residents confirmed they were happy with the way staff treated them. Discussions with staff highlighted some examples of resident’s wishes and preferences being acted upon. One staff member, discussing routines on her unit, reported how some residents preferred a bath or a shower every day, others just several times per week. In addition some residents preferred their bath in the evening before bed, and this was adhered to by staff in that unit. Cobgates H58 S33558 Cobgates V226349 280705 Stage 4.doc Version 1.40 Page 11 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 standard(s) 12,14 and 15 Cobgates provides a good range of social activities and tasty, nutritious meals which are much appreciated by residents. EVIDENCE: The home offers a number of activities for residents such as a bar which is open on several evenings and (and includes bar games and quizzes), and a weekly bingo. The regular activities programme continues but extra events are limited as the home has just lost its activities organiser. The Registered Manager said the new organiser will be engaged for additional hours per week in order to spend some time with the residents on the new dementia unit. Residents reported enjoying a recent barbecue and a variety of outings. Others who enjoyed reading looked forward to the visits from the ‘library lady’; one resident said she read 7 books per week. A fundraising auction was planned and other more specialist activities such as jam making and wine making, were mentioned in the notes of residents meetings. There was evidence from speaking to residents and looking at the notes taken in residents meetings that the home endeavoured to rnaximise resident’s opportunities for making choices. The inspector recommended that the home identify advocacy organisations who might assist residents, especially residents without friends or family. This will be particularly important when the new dementia wing opens.
Cobgates H58 S33558 Cobgates V226349 280705 Stage 4.doc Version 1.40 Page 12 The meals at Cobgates came in for many positive comments and all those spoken to had good things to say. The hotpot sampled on the day of the inspection was very tasty and, importantly for the other residents at the table who passed comment, the meat was very tender. One resident said the food was ‘wonderful’ and another said it was like ‘being in a four star hotel’. Menus were varied and the kitchen was well organised and hygienic. The cook said that in addition to a cooked lunch, some residents also liked a cooked breakfast, six having a cooked breakfast every morning,and others just having it a couple of times per week. The kitchen was flexible to meet residents needs and any resident who did not want the hot lunch of the day, or the alternative salad, could put in the notebook any other requirements and the cook would do her best to meet them. Notes from residents meetings reported that the new idea of a ‘buffet supper’ had proved very popular. Cobgates H58 S33558 Cobgates V226349 280705 Stage 4.doc Version 1.40 Page 13 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 standard(s) 16 and 18 Residents can be confident that their comments and complaints would be taken into account, and that they are protected from abuse. EVIDENCE: There had been no complaints since the last inspection and residents had a number of ways in which they could raise issues of concern such as resident’s meetings, Regulation 26 visits, and one-to-one discussions with staff on their unit. The home adheres to the Surrey County Council complaints procedure and this was displayed on the resident’s board in each unit. The home adheres to the Surrey County Council multi-agency procedures for the protection of vulnerable adults and a copy of the latest February 2005 version was available in the home. Cobgates H58 S33558 Cobgates V226349 280705 Stage 4.doc Version 1.40 Page 14 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 standard(s) 19,20,21,22,24,25 and 26 Cobgates offers well furnished and hygienic premises, divided into smaller units and with spacious outdoor facilities. This enables residents to live in a homely environment and helps them to maintain a better quality of life. EVIDENCE: The home offers an accessible and safe environment for its residents. There have been a number of decorative improvements since the last inspection including the building and furnishing of the new dementia unit. There has been a lot of work in the gardens and paths have been relaid. However, a disused day centre in the grounds of the home has fallen into disrepair and is unsightly. The inspector recommended that the future of this building be reviewed. The local fire service have been consulted about the fire procedures and are due to visit to assist with a fire practice at the home. The communal areas at Cobgates are exceptionally well furnished, the lounges and dining areas are particularly homely with good quality furnishings and accessories. Even the bathrooms have been nicely furnished and one of the
Cobgates H58 S33558 Cobgates V226349 280705 Stage 4.doc Version 1.40 Page 15 recently decorated shower rooms had a Victorian theme which one of the staff had designed herself. There were sufficient bath and shower rooms and the recently installed new showers were proving very popular with residents. The inspector recommended that the temporary black plastic sheeting used to block out the light in one of the corridors be removed and a more suitable replacement found. The home had a variety of aids and adaptations to meet the needs of existing residents, however there were some aids including a hoist which di not have dedicated storage space. The inspector recommended that storage for aids and adaptations, including wheelchairs, should be reviewed. During the tour of the home the inspector saw examples of well furnished and very personalised bedrooms. The sleeping arrangements of one resident however needed reviewing and a replacement found for the existing worn out facility. The manager agreed to do this as a matter of urgency and before the conclusion of the inspection, an alternative had been identified. The inspector also suggested a specialist assessment to confirm the new arrangements met the resident’s needs. The inspector observed the heating, lighting and ventilation to be suitable and met the needs of residents. All water taps available to residents and tested on the day of the inspection were around 43C to avoid scalding. The home have a programme of covering all those radiators which may reach a high temperature and the programme should be completed before the radiators are needed again for the autumn. The home was clean, pleasant and hygienic throughout. A dedicated laundry worker kept the clothes nicely laundered and arrangements were in place to ensure residents own individual clothes were returned to them. The inspector asked that the sluice in one unit which was out of order (and a new part had been ordered), should be chased up with the company as soon as possible Cobgates H58 S33558 Cobgates V226349 280705 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 28 Arrangements for staffing at Cobgates ensure residents needs can be properly met EVIDENCE: The skill mix and number of staff at Cobgates were observed to provide a good level of care and supervision for residents. In addition, staff confirmed they were encouraged to do activities and chat with residents whenever possible. The staff rotas were sampled as part of the pre-inspection questionnaire. The home is going to exceed the requirement to have a minimum of 50 of care staff trained to NVQ level 2 or above by the end of 2005. Cobgates H58 S33558 Cobgates V226349 280705 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,36 and 38. Cobgates is well run and residents benefit by the ethos and management approach of the home. EVIDENCE: The Registered Manager has been in post for some time and is supported by a committed team of staff. There are clear lines of accountability within the home and ongoing reorganisation will mean two deputy posts will replace the previous deputy who is retiring after many years. There was an open and positive atmosphere in the home and there was a clear sense of leadership and direction. There are a number of methods of reviewing the quality of the service and of residents being able to have their say. However, the Surrey County Council internal audit between the different care homes has fallen behind and a
Cobgates H58 S33558 Cobgates V226349 280705 Stage 4.doc Version 1.40 Page 18 requirement will be made in this respect. Staff at Cobgates currently have one-to-one and group supervision, as well as ‘wing meetings’ to discuss issues to do with the care of residents. However, in order to meet this standard fully, each care staff member wilneed to have at least 6 formal and documented supervision sessions per year, on a one-to-one basis with a senior colleague. Health and safety issues within the home were taken seriously and the preinspection questionnaire documented that safety checks were being carried out. The inspector asked for a review of the absence of window restrictors on the first floor and risk assessments will need to be drawn up. Cobgates H58 S33558 Cobgates V226349 280705 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3
COMPLAINTS AND PROTECTION 2 4 3 2 x 3 2 3 STAFFING Standard No Score 27 3 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 2 x x 2 x 2 Cobgates H58 S33558 Cobgates V226349 280705 Stage 4.doc Version 1.40 Page 20 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. 2. Standard 7.1 9.1 9.7 Regulation 15(1) 13(2) Requirement The home must complete the review and updating of residents care plans and risk assessments. The home must complete its review of the administration of medicines and ensure that staff training is up-dated as soon as possible. The disused day centre in the garden has fallen into disrepair and is unattractive. A decision must be made about its future and it should either be removed or steps taken to hide or improve the facade. The home must review and identify storage areas so that provision is made for the storage of aids and equipment The home must review the sleeping arrangements of one resident and provide an alternative as discussed with the Registered Manager. The remaining radiator covers must be fitted as soon as possible and before the radiators are needed again in the autumn. The internal quality assurance system has not been fully actioned over the last 12 months Timescale for action 28.08.05 28.08.05 3. 19.3 23(2)(o) 28.09.05 4. 22.7 23(2)(l) 28.09.05 5. 24.1 16 (2)(c 04.08.05 6. 25.5 13(4)(a) 28.08.05 7. 33.1 24(1) 28.10.05 Cobgates H58 S33558 Cobgates V226349 280705 Stage 4.doc Version 1.40 Page 21 8. 36.2 18(a) 9. 38.3 13(4)(a) and the home must take steps to rectify this. Formal and documented 28.10.05 supervision of care staff must take place at least 6 times per year. The home must carry out a risk 04.08.05 assessment and take appropriate action regarding the absence of window restrictors on the first floor windows. 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. Refer to Standard 8.6 12.1 Good Practice Recommendations The home should review its use of incontinence aids and provide these only where the resident has been assessed as needing them. The home should appoint a replacement activities coordinator as soon as possible in order to maintaion the good range standard of activities to which residents have become accustomed. The home should explore the use of independent advocates, especially for residents without family or friends. The home should chase up the spare part needed for one of the sluices and have this repaired as soon as possible. 3. 4. 14.3 26.6 Cobgates H58 S33558 Cobgates V226349 280705 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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