CARE HOMES FOR OLDER PEOPLE
Colbury House Nursing and Residential home Hill Street Totton Southampton SO40 2RX Lead Inspector
Carole Payne Unannounced 24.05.05 9:00am 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. Colbury House Nursing and Residential home H54 S11420 Colbury Hse V228203 240505.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Colbury House Nursing and Residential Home Address Hill Street, Totton, Southampton, SO40 2RX 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) 023 8086 9876 023 8086 7119 Mr J Collins Mrs M R Collins Ms C Harris CRH 40 Category(ies) of OP - 40; PD - 6; PD(E) - 28; DE(E) - 17 registration, with number of places Colbury House Nursing and Residential home H54 S11420 Colbury Hse V228203 240505.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No more than 6 beds may be used at any time for service users in the category of PD between the ages of 50-65. 2. No more than 17 beds may be used at any time for service users who are only in need of personal care. Date of last inspection 15.12.04 Brief Description of the Service: Colbury House Nursing and Residential Home is situated in Totton, in a quiet lane, surrounded by pleasant countryside and close to the New Forest. The home provides accommodation for up to forty people over the age of sixty five. Up to seventeen of these places are available for people with dementia and twenty eight for service users with a physical disability. Up to six places can be used for service users with a physical disability aged between fifty and sixty five. Accommodation is arranged on two levels. The home has a pleasant lounge with views over the homes gardens and there is a dining room. There are seven shared rooms and twenty six single rooms. The home benefits from twenty eight en suite rooms. Nine places are located in a coach house, which benefits from a communal kitchen and sitting room. The home is owned by Mr and Mrs Collins. Mrs Collins takes an active part in the day-to-day running of the service. Christine Harris is the registered manager of the home. There are close links to the M27 motorway and the nearby amenities in Totton and the city of Southampton.
Colbury House Nursing and Residential home H54 S11420 Colbury Hse V228203 240505.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The home’s first inspection for this year took place on the 24th May 2005 between 8.50 and 16.30. The visit was unannounced. During the inspection discussions took place with eight of the thirty-eight people living at the home, Mrs Collins, one of the registered providers, the manager, two care staff members and a health care professional visiting the service. The home was accommodating seventeen service users suffering from dementia and two people between the ages of fifty and sixty-five. Care records were seen for four service users, policies and procedures were sampled and the daily routine was observed in the home. What the service does well: What has improved since the last inspection?
Since the last inspection the home’s statement of purpose has been reviewed. The home now has a copy of The Control and Administration of Medicines in Care Homes. This is used in conjunction with the home’s own policy for the administration of medicines. The home now follows the Royal Pharmaceutical guidelines regarding the crushing of medicines, the temperature of the drugs fridge is recorded, creams
Colbury House Nursing and Residential home H54 S11420 Colbury Hse V228203 240505.doc Version 1.30 Page 6 and emollients were appropriately labelled with the names of service users currently living in the home. The home’s registered persons are aware of robust procedures for responding to suspected abuse as required in the last inspection report. The home’s policy has been updated. A summary sheet has been devised to track the process of recruiting new staff to work in the home, to ensure that staff members do not start work until all checks have been carried out. Since the last inspection one of the registered providers has started to make unannounced visits to the service each month and produce a report, as required by regulation, monitoring that the home is run in the best interests of service users. Since the last inspection a programme of appraisal and formal supervision has commenced. 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.
Colbury House Nursing and Residential home H54 S11420 Colbury Hse V228203 240505.doc Version 1.30 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 Colbury House Nursing and Residential home H54 S11420 Colbury Hse V228203 240505.doc Version 1.30 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) 1 3 5 The home’s statement of purpose has been appropriately reviewed. A suitable and detailed assessment is carried out to ensure that the needs of service users moving into the home can be met. Prospective service users and their families and friends are welcome to visit and spend time at the service prior to making a decision about moving in. EVIDENCE: The home’s statement of purpose has been updated and reviewed as advised in the last inspection report issued to the home. Assessments were viewed for two service users who had recently moved into the home. The home has a detailed format, which is used to assess the needs of service users who are considering moving into the home. A discharge summary was also included in the records seen. The forms provided a detailed summary, ensuring that the needs of the people considering moving into the home could be met by the service. The provider described how one service user’s family had come to look around the home and a room had been reserved until the service user was ready to
Colbury House Nursing and Residential home H54 S11420 Colbury Hse V228203 240505.doc Version 1.30 Page 9 move in. In the meantime the service user’s family had been made welcome to come into the service to make preparations. One service user said that although she had been unable to come and look around the home, her family had been made welcome. Colbury House Nursing and Residential home H54 S11420 Colbury Hse V228203 240505.doc Version 1.30 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 standard(s) 7 8 9 10 Service users’ needs are set out in detailed and well-maintained care plans. These reflect needs identified from assessments. Service users’ healthcare needs are satisfactorily met. They are offered the opportunity to administer their own medicines and good procedures are in place to ensure that medicines are administered safely. Effective training is in place to teach staff members about how to treat service users with respect and dignity. Service users feel that staff members are very ‘caring’ and ‘kind.’ EVIDENCE: Care records were sampled for three service users. Assessments completed prior to, and on admission, to the service were detailed and risk assessments reflected service users’ current needs. There were risk assessments for manual handling, nutritional and pressure sores. Dependency levels are recorded as part of the home’s pre-admission assessment. Where risks had been identified these were reflected in the care plans. The care plans included references to the individual needs of service users, including personal care, health and social care needs. The manager confirmed that service users, or their relatives, had been involved in the development of the plans, if able. Colbury House Nursing and Residential home H54 S11420 Colbury Hse V228203 240505.doc Version 1.30 Page 11 During the visit service users spoke of contact with dental and optical services. The home is served by four GP services. The manager had contacted the GP to visit a service user at the time of the visit. The manager confirmed that healthcare professionals visit the service appropriately. The diabetic nurse, she said, had recently visited the service to screen service users suffering from diabetes and specialists such as the dietician and the psycho geriatrician are involved as necessary. A memory nurse is visiting the service and undertaking a research project with the help of some of the service users. Contact sheets are kept of involvement of the multi-disciplinary team. The nursing homes’ assessment nurse was visiting the service and said that she often sits in the home’s reception area, whilst she carries out her written work. She said that she is impressed by the caring approach of some members of staff, particularly in meeting the needs of some service users who are particularly dependent upon the help and care given. Issues highlighted during the last inspection visit to the home were reviewed. Medication administration records were seen for two people living in the home, which corresponded to medicines held by the service. The manager undertook to follow up on an occasion where the reason for omission of a medication had not been recorded. A current stock level was seen of creams and emollients were seen and the manager confirmed that all were for service users currently living in the home. All creams seen were labelled. During the visit medicines were collected for return to the pharmacy for disposal. The manager stated that no service users were administering their own medicines at the time of the inspection. The home has a copy of The Control and Administration of Medicines in Care Homes. This is used in conjunction with the home’s own policy for the administration of medicines. Consent was seen on file from the General Practitioner for one service user to receive medicines, which have been crushed. The home follows the Royal Pharmaceutical guidelines regarding the crushing of medicines. The temperature of the drugs fridge is now being recorded. Staff members were observed giving sensitive support to service users. One service user said that staff members are ‘kind’ and ‘helpful.’ The manager confirmed that members of staff are appropriately supervised in order to monitor practice in terms of protecting the dignity of service users working in the home. Staff members knock on service users’ doors. The manager and the provider have confirmed support and supervision in place for one staff member, who was inexperienced in their approach. A service user said that all carers were very ‘caring.’ Colbury House Nursing and Residential home H54 S11420 Colbury Hse V228203 240505.doc Version 1.30 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 standard(s) 12 14 15 The home has a good range of social opportunities, and actively seeks to learn about services users interests and preferences. People living at the home are able to make choices about their way of life. Service users receive a good diet. People living at the home enjoy meals in pleasant surroundings. EVIDENCE: Service users hobbies and interests are recorded in assessments and care plans. Individual records are maintained of participation in the social life of the home and contacts with family and friends. Activities include regular Wednesday trips out to local places interest, visits from ‘Olde Tyme Music Players’ and prize bingo. One service user said that she is able to make choices about the way she lives. She said that she enjoys spending time in her own room; that she is able to do what she wants when she wants to. Three service users said that they enjoy the food provided by the home. They feel that they are able to make choices. Two people enjoying lunch in the home’s dining room said how much they like taking meals together. Tables are attractively laid. Colbury House Nursing and Residential home H54 S11420 Colbury Hse V228203 240505.doc Version 1.30 Page 13 The home caters for specialist diets including diabetics and vegetarian. One service user who does not eat meat said how much she appreciates the efforts that the cook goes to, providing a range of meals that she really enjoys. The home’s pre-admission assessment includes references to service users’ allergies to particular foods so that the home is able to plan appropriately. One service user living at the home is allergic to eggs. Service users’ breakfast preferences are separately recorded so that individual wishes can be catered for. Colbury House Nursing and Residential home H54 S11420 Colbury Hse V228203 240505.doc Version 1.30 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 standard(s) 18 The home has good policies and local guidance available, which, along with a recently acquired training programme, act to protect service users from abuse. EVIDENCE: The home’s registered persons are aware of robust procedures for responding to suspected abuse as required in the last inspection report. Staff awareness has been raised of local adult protection protocols. This was discussed during the last trained staff meeting at the home. A training programme in adult protection has been obtained and there are plans to cascade this to all staff members. The home has a copy of the local adult protection policy and has its own policy in relation to responding to incidents of suspected abuse. Colbury House Nursing and Residential home H54 S11420 Colbury Hse V228203 240505.doc Version 1.30 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 standard(s) Standards not assessed on this occasion. EVIDENCE: Colbury House Nursing and Residential home H54 S11420 Colbury Hse V228203 240505.doc Version 1.30 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) 29 Service users are not currently adequately protected by the homes recruitment policy and practices. EVIDENCE: Issues regarding recruitment records have been raised in previous inspection reports issued to the home. Nine recruitment summary records were seen, of which three individual recruitment files were viewed. Three files contained one reference. A staff member started work at the home on 2nd April 2005. References were not received until 3rd May 2005. The home had not applied for its own Criminal Records Bureau check. A check had been brought from a previous employer. Criminal Records Bureau checks cannot be carried from one employer to another. The administrator chased outstanding references on the day of the inspection, written details of which were provided. The home has also written to the Commission for Social Care Inspection since the inspection to confirm that the home has requested the Criminal Records Bureau check outstanding. Seven POVAFirst checks had been obtained for new members of staff tracked prior to starting work at the service under supervision. In the three files seen work histories and dates of employment had been obtained. Colbury House Nursing and Residential home H54 S11420 Colbury Hse V228203 240505.doc Version 1.30 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 33 36 38 The service is well managed by the registered manager who works effectively with one of the registered providers. The providers monitor the service to ensure that it is run in the best interests of service users. Staff members are appropriately supervised. Fire and food safety, and policies for the safe moving of service users, protect the welfare and health of people living in the home. EVIDENCE: Since the last inspection the manager has undertaken a medicines update. She confirmed that she is commencing study for the Registered Manager’s Award. During the visit she liaised effectively with one of the registered provider’s, Mrs Collins, to organise the day-to-day management of the service. Regular unannounced visits are undertaken to the home by one of the providers to assess the standard of service provided as required by regulation. Regular staff meetings are held in the home.
Colbury House Nursing and Residential home H54 S11420 Colbury Hse V228203 240505.doc Version 1.30 Page 18 Since the last inspection a programme of appraisal and formal supervision has commenced. From discussions with the manager during the inspection, staff members are supervised informally through an effective daily routine. Individual records of fire training and drill practice are maintained. The manager confirmed that all staff are regularly updated. A combination of formal fire instruction, videos and questionnaires are used to support training. Records seen showed that fire alarms are checked on a regular basis. From records seen and discussion with the manager staff members receive appropriate training in manual handling. Manual handling risk assessments are completed for each service user and the manager was in the process of auditing accidents occurring in the home in order to use the information to improve the assessments and minimise any risks identified. At the time of the visit the manager confirmed that eight members of staff were undertaking a distance-learning course in food hygiene. The home has a cook who oversees the preparation of the midday meal and makes appropriate preparations for the evening meal, which is overseen by a member of care staff, who comes in to carry out this role. The manager confirmed that this person and those involved with the handling of food hold a qualification in food hygiene. Colbury House Nursing and Residential home H54 S11420 Colbury Hse V228203 240505.doc Version 1.30 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 3 x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 x 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 2 x 3 x x 3 x 3 Colbury House Nursing and Residential home H54 S11420 Colbury Hse V228203 240505.doc Version 1.30 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. Standard 19 Regulation 29 Requirement Two written references must be obtained before appointing a member of staff. (This has been a requirement in five previous inspection reports; last timescale of 31.01.05 not met) A satisfactory Criminal Records Bureau check must be in place before new staff members are confirmed in post. (Previous timescale of 30.06.04, 31.01.05 not met.) An action plan must be submitted to the Commission for Social Care Inspection as to how the shortfalls identified during the inspection are going to be addressed. POVAFirst and Criminal Records Bureau checks to be obtained for one staff member. A second reference to be obtained for three staff members. This was issued as an immediate requirement at the time of the inspection. The home has complied with this requirement. These staff members must work under supervision until the required checks are returned as
H54 S11420 Colbury Hse V228203 240505.doc Timescale for action 30.06.05 2. 19 29 25.05.05 3. 19 29 30.06.05 Colbury House Nursing and Residential home Version 1.30 Page 21 stated in the Department of Health Guidelines for The Protection of Vulnerable Adults.. 4. 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. Refer to Standard Good Practice Recommendations Colbury House Nursing and Residential home H54 S11420 Colbury Hse V228203 240505.doc Version 1.30 Page 22 Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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