CARE HOMES FOR OLDER PEOPLE
Cooper House Pasley Road Eyres Monsell Estate Leicester Leicestershire LE2 9BT Lead Inspector
Ruth Wood Unannounced Inspection 2nd August 2006 09:30 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 Cooper House DS0000037637.V306014.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cooper House DS0000037637.V306014.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Cooper House Address Pasley Road Eyres Monsell Estate Leicester Leicestershire LE2 9BT 0116 2782341 0116 2782341 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) socis209@leicester.gov.uk Leicester City Council Vacant Care Home 29 Category(ies) of Dementia - over 65 years of age (20), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (20), Old age, not falling within any other category (29), Physical disability over 65 years of age (5), Sensory Impairment over 65 years of age (10) Cooper House DS0000037637.V306014.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service User Numbers DE(E) & MD(E) No one falling within category DE(E) or MD(E) may be admitted into Cooper House when 20 persons who fall within categories/combined categories DE(E) or MD(E) are already accommodated within the home Service User Numbers PD(E) No one falling within category PD(E) may be admitted into Cooper House where there are 5 persons of category PD(E) already accommodated within the home Service User Numbers SI(E) No one falling within category SI(E) may be admitted into Cooper House where there are 10 persons of category SI(E) already accommodated within the home 8th December 2005 2. 3. Date of last inspection Brief Description of the Service: Cooper House Residential Home is registered to provide accommodation for up to twenty-nine older people and is owned by Leicester City Council. The home is situated in a residential area, close to shops, GP surgery and other local amenities. The home is on the main road and on a bus route with the bus stop directly outside the home. Car parking is available to the front of the home. Cooper House is a large modern and purpose built property. Accommodation is offered on the ground and first floor level, which can be accessed by a passenger lift. Bath/shower and toilet facilities are located throughout the home. There is a landscaped garden to the front and a small patio to the side of the home, close to the lounge and dining room. A new conservatory has been built with a patio that overlooks the large garden to the rear of the home. All areas of the home are accessible to people using mobility support, aids and equipment. Cooper House DS0000037637.V306014.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on a weekday between 9.30am and 5.30pm. A tour was made of the communal areas and several residents’ rooms were also viewed. Discussion was held with seven residents, staff members, the acting manager, relatives and a social services reviewing officer. Care practice was directly and indirectly observed and a variety of records (care, medication training, financial and maintenance) were examined. The care and support given to three residents in particular was focused upon and this included examining their care records in detail, discussing with them what it was like to live in the home (in two instances) and observation of the care they received. What the service does well: What has improved since the last inspection?
New systems have been put in place by the acting manager, to improve the administration of medication. A separate ‘medication handover’ is held between the senior staff members on duty where any information about drug changes is passed on and quantities of medication are checked to ensure that all residents have had the appropriate medication during the previous shift.
Cooper House DS0000037637.V306014.R01.S.doc Version 5.2 Page 6 Several improvements have been made to the physical environment including extensive planting in the patio area which has been completed by a group of residents; this is now a very attractive feature of the home. During the inspection residents were discussing where to site the new greenhouse and it is hoped that this will become a well-used resource. The reception area has had new automatic doors fitted to make it fully accessible for any person with impaired mobility and all windows in the home have now been double-glazed. 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. Cooper House DS0000037637.V306014.R01.S.doc Version 5.2 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 Cooper House DS0000037637.V306014.R01.S.doc Version 5.2 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): 3 Quality in this outcome area is good. Residents’ needs are comprehensively assessed before they come to live in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three residents’ case files were examined; all contained a full assessment of need completed by the placing social worker together with an outline of needs completed by the home on admission. Please note intermediate care (Standard 6) is not offered by this home. Cooper House DS0000037637.V306014.R01.S.doc Version 5.2 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 the following standard(s): 7,8,9,10,11 Quality in this outcome area is good. Residents are treated with respect, their health and medication needs are well met and care plans reflect their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three residents’ care plans were examined. The acting manager said that all care plans are currently in the process of being updated to ensure that they accurately reflect residents’ needs. This includes the first section of the care plan being written directly from the point of view of the residents themselves. Only one of the three plans examined had been updated into the new format, but plans appeared to be an accurate reflection of needs as observed and discussed with the residents, a review worker and staff members. Plans outline personal care needs and how they should be met; one plan for a resident with dementia gave information as to the ways that person expresses their needs in the absence of formal communication. This is good practice. One resident had a case review during the inspection and their reviewing officer felt that their care plan was a good reflection of their needs and was particularly impressed that risk assessments addressed issues relating to mental health as
Cooper House DS0000037637.V306014.R01.S.doc Version 5.2 Page 10 well as physical risks. Care plans also contained information relating to people’s wishes at the time of their deaths or should they become seriously ill. Care staff write a short report for each resident at the end of each shift which forms the basis of the handover. Entries in these daily reports vary in quality and improvement could be made both in the type of information and the way it is written. For example several entries for all three residents stated ‘all care given’ but did not specify what care. The acting manager should explore ways to improve recording to ensure useful and accurate information is documented. Several residents said that they saw the chiropodist regularly and the acting manager confirmed that both NHS and private chiropodists visited the home. Care plans and discussion with residents and the acting manager also confirmed that they have regular access to GPs, district nurses, opticians, dentists and consultant psychiatrists. Arrangements for the management of medication were discussed at some length with the acting manager who has implemented new procedures to ensure that medication is administered accurately and consistently. The senior member of staff on duty is responsible for administering medication and at the end of the shift makes a count of all medication not contained in blister packs to ensure that it has been administered correctly. This is then counter checked by the new senior staff member taking responsibility for the next shift. All senior staff have received training in administering medication and information relating to the nature of the major groups of medication that they routinely administer. The lunchtime medication round was observed and this was undertaken competently. Residents were asked before being given ‘as required’ pain relief and were not rushed when swallowing tablets. The medication administration record was signed only after the staff member had observed that the resident had swallowed their medication. Interaction between residents and staff was indirectly and directly observed at several times during the inspection. Staff spoke to residents in a respectful manner and used appropriate forms of address. They also modified their communication to suit the individual. For example at lunch time residents with dementia were shown the two choices of pudding and given time to make a decision. Cooper House DS0000037637.V306014.R01.S.doc Version 5.2 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 the following standard(s): 12,13,14,15 Quality in this outcome area is good. Residents are facilitated to make choices and to maintain contact with family, friends and the wider community. They participate in a variety of appropriate activities and enjoy good food in pleasant surroundings. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Several residents spoke about the activities available in the home which include bingo (one resident said “I always win”) and sing-a-longs with outside entertainers. One relative commented that her mother had done flower arranging in the home and several residents have been involved in re-planting the patio garden. One resident had a discussion with the acting manager about the optimum site for a new green house and persuaded the manager that the site originally chosen would not be accessible to all the residents whereas a different site (identified by the residents) would. There are several lounges in the home including ‘quiet’ areas with no television or radio, which are popular with residents who want to chat to each other or to read. One visiting relative said that they had been able to use one lounge upstairs for a family party to celebrate their mother’s birthday. They added that they felt they could visit the home at any time and were always made to feel welcome.
Cooper House DS0000037637.V306014.R01.S.doc Version 5.2 Page 12 There is a dedicated hairdressing room, which has recently been refurbished One resident said that it was also possible to get a manicure, proudly showing her nails to demonstrate. There is a small shop located in the home where residents can purchase such items as toiletries and confectionary. Good links are maintained with the local community with many residents having lived in the area previously and continuing to use local facilities such as the health centre, local shops and the working men’s club. The community library brings a selection of books on a regular basis (including large print) and one resident commented that they appreciated this service as they enjoyed reading. Members of the local community have also fundraised for the home, purchasing such items as a new television for the lounge. Discussion was held with the assistant cook about menu planning and meeting residents’ dietary needs. She, or the cook, tried to meet with the resident and/or their relatives soon after they moved in to find out their likes and dislikes and whether they had any specific dietary needs. They also routinely served meals in the dining room to get ‘feedback’ on what residents liked and disliked (this process was observed) and tried to find out if people wanted any additions to be made to the menu. Residents generally expressed satisfaction with the food, saying that they particularly liked the pancake suppers and the fish and chips. Food served could be described as ‘traditional English’ although suitable provision is made for people from different ethnic or religious groups. Lunch on the day of the inspection was lamb chops with fresh vegetables followed by Bakewell tart or rice pudding; alternatives were available for service users with diabetes. Some residents, who because of dementia find it difficult to choose, were physically shown the alternative dishes to help them in making their decision. The dining room is light and airy and staff assist residents who need help unobtrusively. Cooper House DS0000037637.V306014.R01.S.doc Version 5.2 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 the following standard(s): 16,18 Quality in this outcome area is good. Residents’ concerns are listened to and policies and procedures within the home protect them from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaints procedure is outlined in the service users’ guide, which also includes information about advocacy services. Residents said if they were unhappy about any aspect of care they would tell one of the staff or the manager and felt confident that something would be done about it. One resident spoke at length about the residents’ meetings, which are more formal gatherings where residents (and their relatives) can meet with staff and raise concerns or discuss changes they would like to see in the home. Communication between residents and staff was observed as open, relaxed and friendly throughout the inspection. Discussion with the acting manager and examination of training records demonstrated that staff have received training in adult protection procedures and in managing aggressive behaviour. Previously submitted information about a potential vulnerable adult indicates that the management team is fully aware of its responsibilities and obligations in this area. Cooper House DS0000037637.V306014.R01.S.doc Version 5.2 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 the following standard(s): 19,20,24,26 Quality in this outcome area is good. Residents live in a clean, comfortable home which is suited to their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A full tour of the home was made of all communal areas and the majority of residents’ bedrooms. All communal areas are tastefully decorated and well furnished. The entrance hall has been recently refurbished to make it fully accessible for people who use a wheelchair. Double-glazing has been installed in all windows and five bedrooms have been redecorated. All residents’ bedrooms are highly personalised and contain items that people have brought with them when they moved in to the home. However one resident commented that they had brought very little as they had used the move as an opportunity for a “ good clear out!” The home was clean and fresh smelling throughout and there are dedicated domestic staff. Aprons and gloves are available in all communal bathrooms and staff also use alcohol hand rub to reduce the risk of cross infection. Some staff members have received training in infection control and the acting manager is hoping to extend this training to other staff members.
Cooper House DS0000037637.V306014.R01.S.doc Version 5.2 Page 15 The slope on the first floor corridor identified in the previous two inspections as posing a potential risk to residents with poor eyesight and/or limited mobility, now has a warning sign posted near it on the corridor wall. The acting manager agreed that this was not the ideal response to the identified problem but said that it had been agreed that reflective lights would be fitted to the slope and they were waiting for this work to be completed. Currently there is no ‘handy person’ attached to the home and there is some delay in the completion of minor repairs at this time. Cooper House DS0000037637.V306014.R01.S.doc Version 5.2 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 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. Residents are supported by sufficient numbers of well-trained staff who have undergone comprehensive recruitment procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are four members of care staff on duty during morning shifts together with one senior staff member; in the afternoon there are three care staff on duty again with a senior staff member. In addition to this the acting and/or the deputy manager may also be on duty at this time. Domestic and kitchen staff are in addition to these numbers. The acting manager stated that they had needed to consistently use agency staff to maintain this level of staffing in recent months but tried to use the same agency staff to ensure consistency. The agency staff member on duty at the time of the inspection was observed to have developed a good rapport with residents and an understanding of the understanding of the home’s procedures. Staff recruitment is managed by the City Council’s Human Resource’s team and staff files containing application forms and pre-employment checks are held at this team’s central office. It has been raised consistently at previous inspections that copies of this material should be available for inspection. The acting manager has developed a staff training matrix which identifies which staff have received which training and where re-training is required. Staff are also being invited to bring evidence of all training undertaken into the home for this information to be kept on their training and development record. The City Council offers a comprehensive and ongoing programme of training
Cooper House DS0000037637.V306014.R01.S.doc Version 5.2 Page 17 and the acting manager showed the inspector the diary where individual staff members were identified as attending a variety of training courses such as managing depression, safeguarding adults and infection control. Seventeen care staff hold a National Vocational Qualification (NVQ) in care at level 2 or above which represents 97 of the home’s permanent care staff. The assistant cook said that kitchen staff hoped to start their NVQs in catering in the near future. Cooper House DS0000037637.V306014.R01.S.doc Version 5.2 Page 18 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, 35, 38 Quality in this outcome area is good. Residents live in a well run home where their financial interests and health and safety are safeguarded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has recently advertised for a new manager, the post being vacant due to retirement. The acting manager is currently undertaking her National Vocational Qualification in care at level 4 and holds qualifications relating to staff management. She has several years’ experience both of working in and managing care services. There are formal procedures in place for consulting with residents including regular meetings at which their views are recorded. Good communication with residents was noted throughout the inspection; this included regular communication between the residents and the kitchen staff with regards to the kind of food served in the home. All residents have a lockable drawer in their bedrooms and can choose to lock their bedrooms also. Residents manage their own finances with support either
Cooper House DS0000037637.V306014.R01.S.doc Version 5.2 Page 19 from a relative or solicitors as appropriate. Residents’ financial records showed clear recording and these are regularly audited. Information submitted before the inspection detailed the last service dates for fire systems and extinguishers, electrical appliances, the gas boiler and lifts and hoists. Details of these were checked during the inspection and maintenance has been carried out at appropriate intervals. Records of the routine testing of fire systems and fire practices were also examined. Staff have received training in fire safety, first aid, moving and handling and, where appropriate, food hygiene. Cooper House DS0000037637.V306014.R01.S.doc Version 5.2 Page 20 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Cooper House DS0000037637.V306014.R01.S.doc Version 5.2 Page 21 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. Standard Regulation Requirement Timescale for action 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 Cooper House DS0000037637.V306014.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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