Inspection on 06/12/05 for Cobgates

This inspection was carried out on 6th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Cobgates 31/07/06

Cobgates 28/07/05

Cobgates 04/01/05

Cobgates 10/08/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

1 Marten Road

St Joseph`s

Ridgemount

Wingham Court

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Cobgates Falkner Road Farnham Surrey GU9 7UG Lead Inspector Helen Dickens Unannounced Inspection 6th December 2005 11:45 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 Cobgates DS0000033558.V271693.R01.S.doc Version 5.0 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. Cobgates DS0000033558.V271693.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Cobgates Address Falkner Road Farnham Surrey GU9 7UG 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) 01252 714834 01252 734256 South West Surrey Adults & Community Care Services Mrs Gaye Munton Care Home 50 Category(ies) of Dementia - over 65 years of age (8), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (1), Old age, not falling within any other category (50), Physical disability over 65 years of age (50), Sensory Impairment over 65 years of age (50) Cobgates DS0000033558.V271693.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Accommodation and Services may be provided to named persons aged 60 - 65 years with the prior written agreement of the CSCI. Respite Care may be provided to a maximum of 5 persons at any one time. Accomodation and services may be provided for a named service user with mental disorder with the prior written agreement of the CSCI. That the residents with dementia are all accommodated on the new unit. The activities organizer should receive specialist training in the provision of activities for clients with dementia. 28th July 2005 Date of last inspection Brief Description of the Service: Cobgates is a two-storey residential care home designed to accommodate older people. It is owned 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 DS0000033558.V271693.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over four and a half hours and was the second inspection to be undertaken in the Commission for Social Care Inspection year April 2005 to March 2006. The inspection was carried out by Helen Dickens, Lead Inspector for the Service. Gaye Munton, the Registered Manager, represented the establishment. A tour of the premises took place. Seven residents and three staff were spoken to in some depth, and an additional number briefly conversed with during the inspection. In addition, a number of files and documents were examined as part of the inspection process. This report covers fewer standards than the previous one, as the majority of key National Minimum Standards were examined at the previous inspection. The inspector would like to thank the residents, staff and manager for their time, assistance and hospitality. What the service does well: What has improved since the last inspection? Most of the requirements from the previous inspection had been dealt with including the fitting of radiator covers, re-starting the internal quality assurance system, and increasing staff supervision. All four of the recommendations from the last inspection had now been met. Cobgates DS0000033558.V271693.R01.S.doc Version 5.0 Page 6 The new dementia unit has opened and is doing very well; residents were settled and happy and the unit was offering a good standard of care to these residents with special needs. The garden for this unit is secure but is going to undergo further improvement; a local charity called ‘Hedgehogs’ has raised £1,500 towards turning it into a ‘sensory’ garden for residents. The home had started to build relationships with local groups and in particular the local Alzheimer’s Society were planning to hold their carer’s support meetings at Cobgates. All the lights in the home were being replaced; the wings had been done already, and the central areas were being done on the day of the inspection. As a result of requests at resident’s meetings, a number of changes have taken place since the last inspection. Cobgates has acquired a cat, Tabitha, from an animal rescue centre, and she is settling in well on Aster unit. Also, tea is now served on each wing, rather than residents going to the main dining room in the afternoon. This gives residents and staff more flexibility about what they eat, and at what time; all residents spoken to said they were pleased with the food. One resident who was particularly enthusiastic on this subject said, ‘The food here is very good… and plenty of it too….nobody can grumble.’ An activities co-ordinator has been employed since the last inspection. Residents reported that she ‘was very nice’ and they were pleased with the activities on offer. A new handyman/gardener has started and was already making a difference around the home. Cobgates have also recruited a second deputy manager who has taken special responsibility for staffing and health and safety. This completes the senior management team. Senior staff are doing an advanced distance-learning course in the administration of medication. What they could do better: Some of the requirements from the last inspection have not yet been met including ensuring that residents care plans are kept up to date and regularly reviewed. As requested at the last inspection, a review was carried out and the decision has been taken to knock down the unsightly disused day centre building in the grounds; however, this will not be done until the new financial year. During this inspection the manager was asked to arrange an up-date for staff regarding the February 2005 multi-agency procedures for the protection of vulnerable adults. Some minor decorative issues were noted including cracks in the walls in the new Aster unit; these were being identified as part of the ‘snagging’ list for the builder to deal with. Cobgates DS0000033558.V271693.R01.S.doc Version 5.0 Page 7 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 DS0000033558.V271693.R01.S.doc Version 5.0 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 Cobgates DS0000033558.V271693.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Please see the previous report. EVIDENCE: Cobgates DS0000033558.V271693.R01.S.doc Version 5.0 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 and 9 Care plans at Cobgates continue to improve but further work needs to be done to meet this standard in full. The administration of medication is well organised at this home. Some staff require further training in order to fully meet this standard. EVIDENCE: Care plans at Cobgates continue to improve and a number of those reviewed had been very well done by one member of staff. The care plans for two of the residents with dementia had a good overview of their assessed needs and captured very clearly the difficulties raised by their dementia. Of the other care plans examined, not all were complete, and some were overdue for review. The recent Regulation 26 visit had also highlighted these issues. The manager will continue to work on a system to rectify this shortfall and a further requirement will be made. Medication administration is well organised at Cobgates. The community pharmacist visited the home recently and found the following: • New arrangements for the storage of medication are good; • Medication administration records are well kept; • Resident’s who are self medicating (inhalers only) are well controlled. The pharmacist also noted some minor issues which were discussed with staff. Cobgates DS0000033558.V271693.R01.S.doc Version 5.0 Page 11 A medication error at this home resulted in a multi-disciplinary meeting to consider what had happened and any further actions required. The conclusion was that Cobgates had taken the appropriate action in a timely fashion once the mistake had been realised, and the home’s suggestions to improve the safe administration of medications were sufficient. The outcome was also reviewed by the CSCI inspector who came to the same conclusion. On the day of the inspection, a respite resident administering his own medication had signed a disclaimer, but no risk assessment was in place. The lockable draw provided for him to store his medicines was not tall enough to take a bottle of liquid, and this had been left on the dresser. The manager arranged to have these last two matters dealt with straight away. Senior staff at Cobgates are undergoing an advanced distance-learning course on the administration of medication. The issue regarding extra training for all staff is highlighted under Standard 30 below. Cobgates DS0000033558.V271693.R01.S.doc Version 5.0 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 and 13 Activities and leisure opportunities at this home satisfy resident’s social and recreational interests. Residents at Cobgates are supported to maintain family and community links. EVIDENCE: The new activities organiser was proving popular and resident’s reported positively on the activities she was arranging. In addition, there were Christmas activities planned such as a resident’s and staff Christmas lunch, where staff dress up; a pantomime; and a Santa’s Grotto where all residents would be given Christmas presents. Some residents also have their own activities for example one gentleman showed the inspector his flat screen TV and digital radio and CD player, which he liked to listen to in his room. On the day of the inspection a visit to the dementia unit found the residents sitting in the lounge area listening to music and chatting with staff. The manager said visiting times are flexible and this is confirmed in the resident’s pack. Residents are free to see whom they choose, and to refuse visitors if that is their wish. There were opportunities for residents to maintain involvement in the local community including seasonal activities (mince pies and carols at the local church the previous afternoon), and regular activities such as shopping and eating out locally. Cobgates DS0000033558.V271693.R01.S.doc Version 5.0 Page 13 Cobgates DS0000033558.V271693.R01.S.doc Version 5.0 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 Complaints at this home are properly dealt with and the arrangements for the protection of vulnerable adults are good. EVIDENCE: The complaints book was sampled as part of the inspection process and one complaint had been received since the previous visit. This was clearly documented and properly dealt with according to the home’s procedures. The home reports any instances that may affect the well being of residents to each resident’s care manager. This ensures that any vulnerable adults issues are highlighted to the local authority in a timely fashion. An issue with a medication error at the home demonstrated quite clearly that residents would be properly protected by the homes policies and practises. The latest version of the Surrey multi-agency procedures for the protection of vulnerable adults is available in the home. The inspector suggested keeping the procedures in a place that is more accessible to all staff. The three yearly refresher training is planned for staff in 2006 but interim training is needed as outlined under Standard 30 below. The home also had a copy of the Department of Health guidance on the protection of vulnerable adults register. Cobgates DS0000033558.V271693.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 21 The residents at Cobgates live in a safe, well-maintained and homely environment. EVIDENCE: Cobgates is located close to Farnham town centre and is accessible, safe and well maintained. A programme of renewal and decoration keeps the home in a good state of repair. The lights have been replaced throughout the home and the reception area was the last area to be completed; this was happening on the day of the inspection. The home meets resident’s individual and collective needs. It was noticeable that small groups of residents were gathered in their favourite ‘quiet’ areas around the home; one group in an area off the main reception, and another upstairs in one of the very comfortable ‘mini’ lounges at the top of the stairs. Others were in the unit lounges (of which there are seven) and others in their own rooms. The layout of the communal areas in Cobgates and the attention to a homely environment gives residents more opportunities to socialise and spend time with others. Cobgates DS0000033558.V271693.R01.S.doc Version 5.0 Page 16 The builder who had worked on the new Aster unit was at the home on the day of the inspection making a ‘snagging’ list of minor repairs which needed to be finished off. The toilets and washing facilities at Cobgates are excellent. The attention to detail with regard to the furnishing and decoration of these areas is very good – for example the toilet and separate bathroom on one wing has an apricot theme with walls, curtains and blinds, pictures etc all co-ordinated to create the overall stylish ‘look’. Another bathroom has the ‘Victorian’ theme and is co-ordinated accordingly. Needless to say the bathrooms are clean, tidy and odour free. Cobgates DS0000033558.V271693.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 and 30 Recruitment at this home is well organised and protects resident’s interests. Staff are generally well trained and competent to do their jobs. Some further training is needed in order to meet this standard in full. EVIDENCE: Recruitment procedures have been reviewed and standardised in all Surrey County Council establishments. The policy is based on equal opportunities and arranged through the ‘shared service’. The inspector viewed a checklist of all the information collected with regard to job applicants and new recruits and sampled two staff files. Application forms, two references, CRB and povafirst checks had been carried out. A full work history had been obtained and gaps in employment explored. The manager said that though some staff start before their CRB check has been received, these staff would always be properly supervised. The new recruitment arrangements meet the National Minimum Standards, as did the previous arrangements. However staff commented that the new system is more cumbersome and time consuming for them, and not as flexible, particularly with regard to the use of agency staff. Staff training is given a high priority at this home and good records have been kept regarding all the training courses, and which staff attended. The manager said staff all have in excess of the three days set down in the National Minimum Standards. In addition to mandatory training, this year the staff at Cobgates have all had a two day course in dementia care prior to the opening Cobgates DS0000033558.V271693.R01.S.doc Version 5.0 Page 18 of the new unit. Those staff likely to be working on the unit after it opened also had an extended 4-day course which covers all aspects of dementia care in more depth. The kitchen staff also went on a course covering cooking and nutrition for people with dementia. All staff are currently doing an infection control course. It was noted that further training is required in a couple of areas. All staff will be having a refresher course on protecting vulnerable adults in 2006, but in addition, the manager was asked to arrange some interim training on the February 2005 Surrey County Council procedures. The manager suggested covering the changes in the new procedures during a staff meeting in the near future. The previous inspection looked at the administration of medicines and made a requirement on further staff training back in July 2005. Though senior staff have already started a distance-learning course on this subject, the remainder of staff at Cobgates are not booked on a medication administration refresher course until January 2006. A further requirement will be made in this regard. The induction at Cobgates for new staff is thorough and the induction folder sampled for a new member of the care team showed good progress on all aspects of care work, health and safety, communication, and confidentiality. Cobgates DS0000033558.V271693.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 and 38 Resident’s are protected by the home’s arrangements for supporting them to manage their own money. The health and safety of residents, staff and visitors is promoted at Cobgates. EVIDENCE: Residents at Cobgates who can manage their money independently, do so. All residents have a lockable draw for the safekeeping of valuables. The majority of residents at Cobgates have ‘an account’ at the home where they can deposit money to fund hairdressing, chiropody, newspapers etc. The home has a special bank account where this money is kept separately from other monies. A record is kept of each resident’s account showing anything paid in or out. Residents have no need to keep large amounts of cash as anything they need can be paid for by Cobgates and then reimbursed from the residents account. There are also arrangements in place to give cash to residents at any time. Cobgates DS0000033558.V271693.R01.S.doc Version 5.0 Page 20 The bursar and administrative team operate this system and it is quite separate from the care team and their work. Health and safety is taken seriously at this home and requirements made at the last inspection regarding health and safety have been carried out in a timely fashion. Water temperatures sampled on the day of the inspection were found to be around 43C, the hazardous substances cupboard and sluices were locked, medicine cupboards on each unit were also locked, and window restrictors were on all those windows examined. The Council’s legionella policy states that water is stored at 60C-65C to prevent the survival of legionella bacteria; hot water temperatures are controlled at the point of use, and a company has a contract with the landlord to arrange the water testing. On the day of the inspection the latest certificate confirming legionella safety was not available and a Requirement will be made in this regard. A cleaning spray had been left in an upstairs bathroom cupboard and this was removed immediately by a member of staff. All hazardous substances need to be stored securely for the safety of residents. Some issues regarding medication (a new risk assessment for self-medication is required, and liquid medicines must be stored safely) are highlighted under Standard 9 above. Cobgates DS0000033558.V271693.R01.S.doc Version 5.0 Page 21 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X 4 X X X X X STAFFING Standard No Score 27 X 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 2 Cobgates DS0000033558.V271693.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15(1) Requirement The home must complete the review and updating of residents care plans and risk assessments. (Outstanding from 28.08.05) The home must ensure that all staff receive up-dated training on the administration of medication. (Outstanding since 28.08.05) The home must ensure that residents who are administering their own medication have an up-to-date risk assessment and suitable lockable storage facilities. Staff must receive refresher interim training on the 2005 Surrey multi-agency procedures for the protection of vulnerable adults as soon as possible. Outstanding medication training is highlighted above. The certificate of legionella safety must be available for inspection in the home. Timescale for action 06/02/06 2. OP9 13(2) 15/01/06 3. OP9 13(2) 07/12/05 4. OP30 13(6) 06/01/06 5. OP38 13(4)(c ) 06/01/06 Cobgates DS0000033558.V271693.R01.S.doc Version 5.0 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Cobgates DS0000033558.V271693.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Surrey Area Office 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 © 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 Cobgates DS0000033558.V271693.R01.S.doc Version 5.0 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!