Inspection on 03/05/06 for Coniston House Residential Home

This inspection was carried out on 3rd May 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Coniston House Residential Home 22/10/07

Coniston House Residential Home 27/04/07

Coniston House Residential Home 16/11/05

Coniston House Residential Home 04/05/05

Coniston House Residential Home 05/01/05

Coniston House Residential Home 24/08/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Coniston House Residential Home 75-79 Orwell Road Felixstowe Suffolk IP11 7PY Lead Inspector John Goodship Key Unannounced Inspection 3rd May 2006 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 DS0000060116.V289015.R01.S.doc Version 5.1 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. DS0000060116.V289015.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Coniston House Residential Home Address 75-79 Orwell Road Felixstowe Suffolk IP11 7PY 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) 01394 276201 01394 276201 Enviro Medical Limited Ms SallyAnn Royal Care Home 26 Category(ies) of Dementia - over 65 years of age (7), Old age, registration, with number not falling within any other category (26) of places DS0000060116.V289015.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 Approval to care for one person under the age of 65 whose name was made known to the Commission For Social Care Inspection on 28 September 2005. 16th November 2005 Date of last inspection Brief Description of the Service: Coniston House is a registered care home for older people situated in a residential area of the coastal town of Felixstowe, close to town centre amenities and the seafront. The home was first registered in 1984 and was bought by Enviromedical Ltd in June 2004. This organisation also runs a similar home in Southend-on-Sea. The home was originally registered to provide accommodation and care for up to nineteen older people but in 1999 was extended into the property next door and is now able to accommodate up to twenty-six service users. There is private parking to the rear of the property. The rear gardens of the property have been landscaped to provide a particularly pleasant area for service users to spent time in the more clement weather. Service user accommodation is sited on three floors all of which are serviced by 2 shaft lifts. There are twenty-two single rooms and two shared rooms. 75 of rooms have the advantage of ensuite toilet facilities. DS0000060116.V289015.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place in the morning. The manager was away on an out-of-county assessment. The deputy manager was present. This key inspection examined those national standards listed as “core” under each Outcome Group overleaf. The inspector toured the home, spoke to six residents in communal areas, and one person in their own room. Staff also spoke to the inspector as a group and individually. Records were examined in the office. Previous information gathered from the last inspection in November 2005, and from documents and records gathered since then, have been used to inform the judgements in this report. What the service does well: What has improved since the last inspection? Information for prospective residents is now complete. Appropriate training is given to new staff at the right time. The directors of the company are making monthly visits and sending reports to the Commission. Other reporting requirements are being met. DS0000060116.V289015.R01.S.doc Version 5.1 Page 6 Care plans have been changed to the new format, and are more comprehensive and informative. There is a suitable hoist on each floor. A programme of staff supervision has started but only one person has so far had a recorded session. 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. DS0000060116.V289015.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000060116.V289015.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. Standard 6 is not applicable to this home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service, and the outcomes of previous visits. New residents can be assured that they will only be admitted to the home if it can meet their needs. EVIDENCE: The Statement of Purpose and Service Users’ Guide had been updated to include the information that the home was now registered for seven places for people over 65 years of age with diagnosed dementia. They also included the items required at the last inspection in November 2005. Examination of the file for the most recently admitted resident showed that pre-admission and admission procedures were being correctly followed. These ensured that all admissions were appropriate to the home, and that the person themselves felt happy with their choice of placement. The manager was not present during this inspection as she was visiting a possible resident in Cambridgeshire for an assessment. DS0000060116.V289015.R01.S.doc Version 5.1 Page 9 No referral of a person with diagnosed dementia had yet been made. Contracts had been revised and issued to those admitted since the new owners took over in 2004. There was no evidence available to determine the position of residents admitted prior to that. DS0000060116.V289015.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information in care plans has improved and is more comprehensive, enabling staff to provide a properly planned and assessed level of care. Medication is administered safely but this will be improved by ensuring that medication is stored at the correct temperature, and that opened bottles are dated. EVIDENCE: The changeover to the new format of care plans was complete. Four care plans were examined, including that for the most recent admission a fortnight previously. The plans included full assessment of needs under aspects of care, together with risk assessments appropriate to each person, including moving and handling and pressure area care. There were as yet no risk assessments for the newest admission nor a photo of them. Because previous care plans were sometimes sketchy and incomplete, there was not yet full information on some residents. This was addressed at care plan reviews. The entries in the daily record in each plan were fuller and more informative than before, giving a record of daily life which could be related to the care plan DS0000060116.V289015.R01.S.doc Version 5.1 Page 11 and used to assess the need for changes. There were still some two word entries covering night times. Where wishes at the time of death were known, these were recorded on the summary sheet on each file. One resident had fallen while walking in the town. This was recorded in the daily record but no Accident Form had been completed. During a tour of the building, a carer was observed supporting a resident through a programme of exercises to improve their mobility and movement following a fractured shoulder. This was being done in their room for privacy. A doctor was in the home at the start of the visit, and a district nurse arrived later to take blood from a resident. It had been noted at a previous inspection that the home enjoyed a prompt and helpful service from the local GP practice. Medication practice remained sound. A sample of MAR charts were examined. All administrations had been signed for with no gaps. Controlled drugs were correctly administered and securely stored. The small fridge in the drug store had no temperature gauge either built in, or fitted separately. Some bottles which were in use had no date showing when they had been opened. These bottles had a limited life after opening. Residents had confirmed at previous inspections that their privacy was respected, and this had been shown on their comment cards. DS0000060116.V289015.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good for some standards and adequate for Standard 12. This judgement has been made using available evidence including a visit to this service. The lifestyles of some residents would be improved by more pro-active work on the interests and preferred activities of residents, individually and in small groups. EVIDENCE: The inspector discussed the range of activities with a group of residents in one of the lounges. They said that there were not enough activities, but were not able to suggest which ones they would like. They did admit that the home did try by putting things on but “most people were not with it enough”. There was a notice on the Board in the corridor listing activities, but, ignoring the library visit, the church service and the hairdresser’s day, the only activities were bingo, video and dominoes. There was no one member of staff with a responsibility to create activities which would attract and maintain the varying interests of the residents. Relatives were frequent visitors, and several people had maintained their community links following their move to the home as most of them had lived locally. Several residents were able to go out for walks on their own, some as DS0000060116.V289015.R01.S.doc Version 5.1 Page 13 far as the town centre. One resident was noted seated at the end of the road enjoying the fine weather. The menu continued to offer two hot choices at lunchtime, with two choices of hot snacks at tea-time. Several residents commented to the inspector that “the food’s very good here”. DS0000060116.V289015.R01.S.doc Version 5.1 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): 16,18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives can be assured that complaints will be investigated fully, and within the home’s procedure. EVIDENCE: There had been a recent complaint from a relative. This was seen to have been fully investigated within the home’s procedure and resolved to the satisfaction of the relatives. Adult protection training was initially covered in Induction courses. One member of staff answered correctly on what action to take if they witnessed abuse. DS0000060116.V289015.R01.S.doc Version 5.1 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): 19,20,21,22,23,24,25,26. Quality in this outcome area is good apart from the lack of water pressure on the top floor. This judgement has been made using available evidence from previous visits and this visit. EVIDENCE: The front door was still unlocked during the daytime. The deputy manager said that this had been discussed with residents and relatives who approved of the policy. Those residents who liked to go out on their own “ always tell us when they go out. The latest Reg 26 report of the monthly visit by a director recorded that gates were to be put on the side driveway to prevent cars swinging round the corner. Although this would improve the security of residents, its primary reason was their safety, as residents liked to sit where cars pull round. The pond in the garden had been assessed, and in view of the wider admission criteria, it had been decided to fill it in for the safety of all residents. DS0000060116.V289015.R01.S.doc Version 5.1 Page 16 Laundry was cramped with 4 machines, one was new with a sluice cycle. The doors into and out of this room were always open during the day, and were used by staff and some residents to access the garden. There was the intention to make this exit safer and to encourage residents to use the patio doors from the sitting room. The Maintenance man was repainting the hallway and corridors as part of a redecoration programme. There was little water pressure in rooms on the top floor. The hot water in 2 rooms on this floor was well below 43 degrees C. Fitted door closers reactive to the sound of the fire alarm were fitted on all doors where the resident wished them to be held open. Appropriate hoisting equipment was now provided on each floor. DS0000060116.V289015.R01.S.doc Version 5.1 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): 27,28,29,30. Quality in this outcome area is good except for the number of staff without an NVQ qualification. The manager is taking active steps to improve this, to give residents the assurance that staff are competent to care for them. The needs of the current residents are met by the numbers of staff on duty on each shift. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were two carers with NVQ2. Another person with NVQ2 had changed onto the night pool.Six to eight staff were awaiting acceptance on NVQ 2 courses, and two staff were waiting for places on NVQ 3. The training file was examined. It recorded all in-house and external training courses and sessions, with qualification or attendance certificates. Medication training records for the Deputy and senior carers were included. The organisation running the Induction and Foundation courses was now able to run them in Felixstowe which helped the staff who lived locally. Mandatory training such as moving and handling, basic food hygiene, and fire training were done on-site by an external training provider. All the documents required by regulation were found in personal files except photo identification. No new person had started supervised work before receipt of a POVA clearance or, in 2 out 3 cases,before receipt of the CRB certificate. DS0000060116.V289015.R01.S.doc Version 5.1 Page 18 Eight staff were studying the distance learning course on dementia run by Otley College. On-site training was planned to provide a one day dementia care awareness training for all other care staff. One person said how useful the course was, in improving care for all residents. One senior carer commented that recruitment had enabled the staffing complement to be reached. There had been a number of new starters but the team was coming together. The staffing levels on each shift were sufficient for the current needs of the residents. The manager was aware that staffing levels would have to be kept under review when the home started to admit people with diagnosed dementia. DS0000060116.V289015.R01.S.doc Version 5.1 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): 31,33,34,35,36,38. Quality in this outcome area is adequate. Residents would benefit from a systematic quality assurance policy so that their views are seen to be taken into account. Residents cannot yet be assured that they are cared for by staff who are being appropriately supervised according to the national standard until the supervision programme has been running for a longer period of time. There are some gaps in the health and safety procedures around accident recording and fire risk assessment which prevent residents being fully protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: DS0000060116.V289015.R01.S.doc Version 5.1 Page 20 The manager was experienced in the care of older people and had undertaken recent training in the care of people with dementia. She had not yet completed her Registered Managers Award. The provider was now undertaking the monthly visits and reports required by the Regulations. There was however no evidence of a systematic quality assurance programme to ensure that residents’ views were sought and used. However, all the residents who spoke to the inspector said that they were well looked after and “the staff are very good”. Each resident’s cash float was kept in a safe in the office. A random check at the last visit showed that the float examined reconciled with the record book. The home was properly covered by Public Liability insurance. The formal supervision of staff had now started and future dates for the year had been arranged. However only one member of staff had so far received their supervision session. The record of this was available. The Accident Book was examined. Pages had not been removed after completion. For data protection they must be stored separately and securely. An accident to a resident outside the home had not been recorded in the Accident Book. There was no Fire Risk Assessment. Testing of fire precautions equipment and fire alarms was regularly done and recorded. DS0000060116.V289015.R01.S.doc Version 5.1 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 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 2 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 DS0000060116.V289015.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement The registered person must make arrangements for the safe keeping and safe administration of medicines, particularly regarding the installation of means of recording the temperature of the drug fridge, and the dating of bottles upon opening. The registered person must consult service users about the programme of activities. The registered person must make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home, by ensuring that water pressures and temperatures are maintained throughout the home. The registered person must ensure that at all times suitably qualified, competent and experienced persons are working at the care home and receive training appropriate to the work they are to perform. The registered person must DS0000060116.V289015.R01.S.doc Timescale for action 30/05/06 2 3 OP12 OP25 16(2) 13(3) 31/08/06 30/05/06 4 OP28 18(1) 31/12/06 5 OP33 24(1) 30/05/06 Page 23 Version 5.1 6 OP38 12(1) establish and maintain a system for reviewing at regular intervals, and improving, the quality of care provided. The registered person must ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users, particularly regarding medication storage, fire risk assessment and accident recording. 30/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000060116.V289015.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 DS0000060116.V289015.R01.S.doc Version 5.1 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. 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