Inspection on 10/03/09 for Cosham Court Nursing Home

This inspection was carried out on 10th March 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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Treloar College

The Marguerite Centre

Thomas Edward Mitton House

The Maypole Nursing Centre

Wardington House Nursing Home

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William House

Twyford Lane (9)

Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Cosham Court Nursing Home 2-4 Albert Road Cosham Portsmouth Hampshire PO6 3DD The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this full assessment a ‘key’ inspection Lead inspector: Anita Tengnah Date: 1 0 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Cosham Court Nursing Home 2-4 Albert Road Cosham Portsmouth Hampshire PO6 3DD (023)92324301 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): coshamcourt@btinternet.com Crossbind Ltd Anne Margaret Hazeldine care home 47 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration Category(ies): old age, not falling within any other category Additional conditions: Number of places (if applicable): 47 The maximum number of service users to be accommodated is 47 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category; Physical disability (PD) Old age, not falling within any other category (OP) Date of last inspection: Brief description of the care home: Cosham Court is registered with the commission for Social Care Inspection to provide nursing and personal care to forty-seven service users in the older persons category. The home can take a total of two service users aged 55 with physical disability and those with terminal illness over 65 years of age. The Home is situated close to Cosham shopping centre and has easy access to both train and local bus services. The majority of the bedrooms are single occupancy. The service users do not have access to a garden but there is a courtyard area and a second sitting area at the side of the building where a conservatory has been erected. Please contact the service for up to date information about the current fees and charges. There are additional charges for chiropody, hairdressing, telephones, Care Homes for Older People Page 4 of 29 D D M M Y Y Y Y newspapers and toiletries. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration How we did our inspection: This is what the inspectors did when they were at the care home. This inspection was an unannounced Key Inspection of the home, a Key Inspection being part of our inspection programme, which measures the service against the key National Minimum Standards, and outcomes for people using the service as part of a process known as Inspecting for Better Lives (IBL). This report incorporates information gained from people using the service and / or their advocates / relatives and staff, including managers and comments from external stakeholders who completed professional comment cards. We were also provided with the services annual quality assurance assessment (AQAA) completed by the manager and other relevant information gained by the inspector via such processes as observations, interviews, inspection of documents and records and case tracking, during a site visit to the home. The visit to the home was undertaken by two inspectors and lasted five hours. Care Homes for Older People Page 6 of 29 What the care home does well: What has improved since the last inspection? What they could do better: The quality of more social and lifestyle related information could be developed further in order to promote more person centred approaches at the home, and greater staff Care Homes for Older People Page 9 of 33 consistency across all aspects of care and support at the service. Care Homes for Older People Page 7 of 29 The arrangements must be in place for the safe keeping of medicines at the care home to ensure that the service users are not put at risks of harm. We found that arrangements for the recording of medications belonging to people newly admitted into Cosham Court needed to be improved. Plans of care and support need to be developed further to promote more person centred ways of recording and working, as current plans were very task based. The service juicers care plans need to provide more detail in a number of areas relevant to nursing care processes such as - PEG feed flushing, agents to thicken drinks for people with swallowing reflex assessments and delivering oxygen as needed. So that peoples healthcare needs are managed safely at all times. The upper floors decoration and some carpets were beginning to look worn and carpets in places were stained. This did not support the provision of a pleasant living environment. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by telephoning our order line – 0870 240 7535. Care Homes for Older People Page 8 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assessed by a suitably trained staff member, prior to moving into the home in order to assure people their needs will be met at the home. The home does not provide intermediate care. Evidence: The annual quality assurance assessment sent to us by the service states Pre-admission assessments are undertaken on prospective residents to ascertain whether the home can meet their needs. This may be done at the home, in hospital, or at the residents own home or current residence. Assessments are also requested from social care managers where possible, or appropriate. We case tracked case records of people living at Cosham Court. Each record was set out on a pre-printed Kardex system. This provided an aid memoir for assessment. There was also documented evidence of pre-admission assessment having been carried out by a suitably qualified person. Assessments covered all areas of daily living, as well as psychological and health care needs. Where people were publicly funded a care manager / social worker had completed one assessment to inform the home of the needs of the person, in addition to providing a Care Homes for Older People Page 10 of 29 contract. We interviewed 8 people living at Cosham court. Residents told us they were happy living at Cosham Court and spoke highly of the staff team. We noted that some assessments and plans of care and support had been signed by the residents concerned. Three people told us they were aware of their support plans and other records held about them, and had an understanding of what the purpose of these records was. People told us they had received information about Cosham Court prior to making a decision to move into the home. Relatives also told us they had been provided with information about the home to enable them and their loved ones to make an informed choice about moving into Cosham Court. Seven survey responses from residents told us they had received information about Cosham Court before deciding to use the home. These surveys included comments such as - Im very happy here. - Im well locked after. - very happy. Cosham Court does not provide intermediate care. However, we were told there is a bed at Cosham Court funded by the local Authority for short stay. Care Homes for Older People Page 11 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health, personal and social care needs are set out in an individualised plan of care. Plans of care and support do not promote a person centred approach for people living at Cosham Court. People were able to make their own decisions about their lives and how they spent their time with assistance when needed. People are supported to take their medicines. Information is not provided in such areas as supporting people with swallowing reflex issues, PEG feeding, Oxygen amounts. Medicines at the service are not managed safely at all times as required . This put the service users at risk of their healthcare needs not being met. People feel they are treated with respect and their rights to privacy upheld and protected where needed. Evidence: The annual quality assurance assessment sent to us by the service states - Care plans are drawn up to cover the individual needs of each resident. These will be discussed with the resident and/or family and will be reviewed regularly and updated as necessary. We case tracked 6 case records of people living at Cosham Court. Each record was set out on a pre-printed Kardex system. This provided an aid memoir for assessment. These documents informed the development of plans of care and support. We found that plans were not person centred. While there was some information about likes and Care Homes for Older People Page 12 of 29 dislikes there was little detail about peoples personal goals and interests reflecting choices. The care plans that that we looked at contained details of assessments such as pressure areas risks and waterlow scores, nutritional assessments and moving and handling assessments to inform the staff practices. We looked at the care records of four people who required support as they were at risk of aspiration due to their poor swallowing reflexes. Details of assessments as completed by a swallowing and language therapist (SALT) was available in one of the records that we looked at. This was being reviewed by the SALT team in one week at the time of the visit. There was no assessment to inform safe practice for the other service users. Another service users pre admission assessment record showed that they had been assessed in hospital as stage 3 risk and required pureed diet and brought in a thickening agent on admission. However there was no care plan in place to demonstrate how the home would be meeting this need, so that they were protected from the risk of choking. The three care records lacked details of the amount of thickening agents that needed to be added to the service users food and drinks in order to manage the risks of aspiration. This put these people a risk of harm through poorly informed care. Detailed instructions on the amount of thickening agents must be developed for each of the service users as part of their plan of care such as the amount of thickening agents, quantity and in which food in order to inform the staff practices and safeguard the people from harm. Two of the service users records showed that they did not receive anything orally and their feeds were administered via a percutaneous endoscopic gastronomy (PEG) tube. The fluid balance records showed the staff were recording the amount of the feeds on their charts. However there were no records of any other fluids that they received and with their medications. Details of these must be recorded to ensure that they receive their prescribed amount of fluids as required. The quality of more social and lifestyle related information could be developed further in order to promote more person centred approaches at the home, and greater staff consistency across all aspects of care and support at the service. The home adopts a monitored dosage system (MDS) for the handling, ordering, storage, administration and recording of drugs and medications at Cosham Court. A random sample of the service users creams and ointments that were in their rooms showed that these were appropriately managed and dispensed to the service users as prescribed. The registered nurses were responsible for the service users medications management. Records of medicines received and discarded were available. A sample of the medication administration record (MAR) charts showed that staff maintained records of medications administered. We noted that some records of medication received were kept, however these were not complete for all the service users. It was not therefore possible to audit the medicines to ensure that people had received their Care Homes for Older People Page 13 of 29 correct amount of medication as prescribed. The registered nurses ensure that all medicines that are transcribed have two signatures to minimise the risk of errors. A procedure for as required medications must be put in place in order to ensure that the service users receive their prescribed medications as required. This means there is no clear guidance to inform the administration of as required medicines consistently in response to the service users needs. Clear records of medications that are discontinued are not be available such as the dates and on whose authority. The care plans for people receiving PEG feeds mus be further developed to include details of flushes needed and also rest periods following medication administration. This applies to the service users who are receiving their medication prescribed as two to three times a day to ensure that this is managed according to guidance and safely. We found that the ground floor office used as the nursing station and holding medications was unlocked. Cupboards holding creams and other like preparations were in cupboards that had also been left unlocked. Thees medicines must be stored securely. Other drugs and medications were maintained safely in the drug trolleys that were found on each floor. Controlled medication was stored appropriately. One person told us they felt their dignity and privacy are respected, but there has to be give and take. They stated they were happy with the quality of support they received and that they are still able to make their own decisions in most areas of their daily life. Another person said they were free to do as they wish within reason, and this person spoke highly of the staff team saying the support they got was very good. Another person stated that they would like to go shopping , but no staff to take you out and they are afraid that if you fall, it will be too expensive for them. We saw a sample of bedrooms while visiting people and speaking to them about their experiences of Cosham Court. We saw that people had been supported and encouraged to personalise their individual rooms in a way they liked and chose. We observed practices throughout our visit and observed staff members intervening in respectful ways with people they were supporting. Seven surveys told us people always received the care and support they needed. Although evidence regarding peoples healthcare needs showed that peoples needs are not always supported by clear guidance. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People experience lifestyles that match their expectations. Action is taken to satisfy social, cultural, religious and recreational interests and needs. However there is a lack of person centred care planning which means peoples preferences may not be met. People are encouraged and enabled to maintain links with the wider community where ever possible, and can have regular contact with family, friends and/or representatives. People are encouraged, supported and helped where needed to make choices and take control over their lives. People receive a wholesome, appealing balanced diet in pleasing surroundings and at time convenient to them. Evidence: The annual quality assurance assessment sent to us by the service states - Residents are recognised as individuals with differing needs, therefore the home aims to make the routines of daily living as flexible as possible. The home offers three meals each day with snacks available in between. The cooks will talk to residents daily (where possible) to assist with their choice of meals. Special diets such as diabetic and pureed options are also catered for. Many residents enjoy having their meals in the dining room and meals can be quite a social occasion. Hot and cold drinks are available at all times as well as being offered regularly. Care Homes for Older People Page 15 of 29 The service users are encouraged to maintain links with their families and friends, as the home recognises the importance of these personal and social relationships. A lounge area is available for residents to meet with relatives/friends/professionals without being disturbed. Families and friends are invited to participate when special events are put on e.g. musical shows and barbeques. Arrangements can be made for a family member, spouse, to share a meal with a resident, either for a special occasion or on a more regular basis. If required, residents are enabled to have their own private phone line installed in their room. The home and especially the activities co-ordinator, actively encourages residents to become involved in activities and even to learn new skills e.g cake making, board games and flower arranging. Residents are encouraged to bring in some possessions to personalise their rooms. This may include items of furniture by prior arrangement if space allows.Information is available for residents and families on how to access help with funding and advocates. There was some evidence that staff had a good understanding of the needs of people, and some staff, such as the activities co-ordinator also had a knowledge of peoples interest. There were activities being organised in Cosham Court that were based on peoples interests, and these were identified in a number of ways, such as via assessments, informally and via quality assurance questionnaires. Due to a lack of person centred planning approaches there was a risk that some peoples preferences may not be known and therefore met. We were introduced to a staff member who has the specific role of activities coordinator. We interviewed staff members who confirmed that activities and entertainments are provided regularly and peoples interests were identified. The people living at the home told us there was always something going on if they wished to join in. The home produce a monthly news letter to let people know what kind of things are going on at Cosham Court over the next four week period. A relative told us they were aware of this in their survey response. We saw the newsletters on display in the entrance area. A care manager told us my client tells me she feels entertained and part of something - at Cosham Court. A GP told us Cosham Court has - All the duties of a well staffed nursing home. We received survey responses from seven people living at Cosham Court. Three people told us there were always activities arranged at the home that they can take part in, four respondents told us there were usually activities. Comments included - there is Bingo and quizzes, and I like it when the entertainer comes in to sing. One person we spoke to told us they enjoyed the cake making. In the afternoon of our visit we saw a number of people engaging in the activities set up in the dining area by staff. There were also two birthdays being celebrated on the day of our visit, and we managed to speak to both of the people concerned who were looking forward to their special day. There were also many visitors. As mentioned above we saw many visitors coming and going during our visit to Cosham Court. We managed to speak to four people visiting either friends or relations living at the home. They all confirmed that they could visit at any reasonable time and were always made to feel welcome. There is a clear policy in respect of visiting, and a visitors book for people to sign in and out in line with fire regulations. People living at Cosham Court told us they could have visitors at any reasonable time, and that their visitors are always made welcome by the staff, even enabling them to stay to have a meal if they wish. Care Homes for Older People Page 16 of 29 While there was a good range of activities on offer at Cosham Court we noted that people were able to choose whether they engaged in these sessions / events. One person told us they were still in control of their life, even though there was some give and take, they could still make their own decisions, and staff supported them with this. Another person told us they liked some of the activities that go on, but did not go to all the things on offer as some were of no interest to them. We visited some people in their own bedrooms and were made to feel very welcome. It was clear people had been encouraged and supported to personalise their bedrooms just as they wished. One person said that they would like to go the shops, but this support was not available to them. We saw food menus. These were planned over a four week cycle. The manager told us the menus were based on the wishes of the residents as far as possible. People were being consulted via resident meetings and questionnaires and surveys sent out to people living at Cosham Court by the manager. Two people we spoke to said the cook often came round and told them what was on the menu, and if there was nothing they liked the cook could always do something as an alternative. The seven surveys returned by people living at Cosham Court said they all always enjoy the meals at the home. Comments included - I very much like the food it is so very good. We spoke to a number of people just after they had eaten their lunch and all said they had enjoyed their meals. One told us they always enjoyed the food at Cosham Court. One person commented that the food was all right but no choice was provided. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. The home has a process in place for protecting people from abuse. However the manager has failed to notify the commission of a safeguarding concern. Evidence: The annual quality assurance assessment sent to us by the service states The home has a clear and accessible complaints procedure. The home keeps a record of all complaints received. The seven surveys returned by people living at Cosham Court told us all the respondents knew how to make a complaint. Comments included - I would talk to the Manager. -To date this has not been necessary. We interviewed four people who were visiting residents at Cosham Court. They all told us they knew how to make any concerns known and how to complain. People told us they felt the manager and staff were all friendly and approachable. One survey response told us any concerns or complaints have been dealt with promptly and to my satisfaction. Other comments included - the staff are very friendly and helpful. We saw a copy of the complaints procedure for Cosham Court. We inspected the complaints book. At the time of sending in the annual quality assurance assessment 4 complaints had been received in the last 12 months. Concerns and complaints had been recorded and logged. These were found to be recorded as resolved to the satisfaction of the persons concerned. We inspected staff training and induction records. There was documented evidence that staff members received training and guidance in respect of safeguarding Care Homes for Older People Page 18 of 29 vulnerable adults. Staff members confirmed that they had received training in safeguarding and were able to demonstrate an awareness of what may constitute a safeguarding issue, and how these were to be reported and managed. We spoke to 6 people living at the home and they all said that they felt safe living at Cosham Court. We have received a safeguarding concern just prior to us visiting the home. The manager advised us that the local authority safeguarding team had attended the home to look into some concerns. The manager failed to report the safeguarding concern to us as required. This was brought to her attention at the time of the visit and we have since received a written notification from the home. Information we have received indicates that the investigation has been completed and the home was taking action on the recommendations that have been made. Social services will be undertaking a further review soon. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a pleasant environment. Some areas of wear and tear to carpets do not support this. There is infection control procedures in place and staff practices showed that they were aware of them. Evidence: The annual quality assurance assessment sent to us by the service states We offer the residents a comfortable place in which to live. Routine maintenance work is carried out regularly by our maintenance man. Residents rooms are reviewed at intervals and redecorated as required. Furniture is provided in bedrooms to a comfortable standard. Communal lounges and dining areas are available for all residents to access. Outdoor areas are also maintained and are accessible by residents. On arrival at Cosham Court we noticed that building works were ongoing. We were advised the current project is to improve and re-site the shaft lift to the upper floors, and to develop a sun room conservatory for residents and to improve the small patio. Two bedrooms had been left empty to enable this work to be carried out to the benefit of people living at Cosham Court. This provided evidence of ongoing investment in the premises. The ground floor was well maintained and the communal dining area was light, bright, clean.The lounges were comfortable and people told us they were happy with their home. The first floor was looking more worn, with many of the carpets badly stained even though we were advised they had only been down for three years. We visited 5 people in their own rooms. Each told us they were happy with their Care Homes for Older People Page 20 of 29 rooms. There was evidence that people had been supported and encouraged to personalise their own rooms as they wished. We spoke to one of the domestic staff who told us they always had the materials they needed to do their job, and had been trained in such areas as infection control. Staff were seen to wear protective gloves and aprons when they were involved in any aspect of work where spread of infection was a risk. We saw infection control fluid dispensers around the home for peoples hands, and there was also a special skin conditioner as people are having to wash their hands so often to reduce risk of cross infection. People living at the home said it was always clean. Six responses to resident surveys told us the home is always clean, and one said usually. Comments included Spotless - Very good. - Very clean. The safeguarding concerns related to concerns that the home is not clean in all areas. The home has a laundry facility for all the service users and the staff we spoke to said that all the laundry was undertaken internally. The laundry room was equipped and maintained in good order. The staff indicated that the care staff were aware of infection control procedures and used the colour coded laundry bags. The soiled laundry were placed in red bags that go directly in the washer and eliminate the risk of contamination and handling. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are mainly met by the numbers and skill mix of the staff. However people say that the staff are rushed and difficulties in communication impact on the care needs of people. The homes recruitment process is generally thorough but must be improved to ensure people are protected. A training programme is in place to support the staff in their roles. Evidence: The annual quality assurance assessment sent to us by the service states Registered Nurses are registered with the Nursing and Midwifery Council. Care assistants receive appropriate training and at least 50 are qualified to NVQ level 2 or above / equivalent. We looked at the staffing at the service and the manager stated that there are three registered nurses and nine carers on duty. We noted that staff were very busy. However, there were separate staff to do domestic chores and a separate staff member to ensure activities took place. Stakeholder feedback stated that staff often seem rushed, and that the home would benefit from having a few more staff on duty. One person living at Cosham Court told us - when you ring the buzzer you can wait ages before they come to answer it. We timed the response to a buzzer and this took place within 2 minutes on the day of the visit. Care Homes for Older People Page 22 of 29 Five people told us the staff were always there when they needed them, three people said they were usually there when they were needed. Comments included - Staff are always there for me. and Yes very helpful. We inspected the records for 3 staff members. We also interviewed staff who confirmed they were well supported at Cosham Court had received good induction into their role and had been been supported to continue ongoing training. Records showed that staff selection and a recruitment process is in place and checks are carried out as part of this process. Records contained criminal record bureau checks (CRB) in the records that we viewed. One of the staff records only contained one written reference. Failure to carry out thorough recruitment checks was raised at the time of the inspection. There was a clear commitment to the ongoing training and development of the staff team. There were clear records of staff appraisal and supervision. There were records of staff training with feedback. We found staff working towards NVQ qualifications at both levels two and three. People made comments such as the staff are very good. Some comments were less positive indicating some staff were perceived as less helpful than others. People told us they sometimes experienced difficulties in making themselves understood to staff who spoke English as a second language. When we discussed this with the manager we were told the home was aware of this issue and worked closely with a local college to provide relevant staff with opportunities to improve their spoken and written English. We were also advised that staff are expected to communicate and to speak to residents in the residents own language when they are on duty at Cosham Court. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a manager who is suitably trained and qualified, is registered and deemed fit to carry out that role. The manager ensures that people are consulted about the running of their home, including having a clear quality assurance system in place. The financial interests of people are safeguarded. Evidence: The annual quality assurance assessment sent to us by the service states The manager holds the NVQ level 4 registered managers award and has been the registered manager at the home for over seven years. She is also a registered nurse. The registered manager was available when we arrived at Cosham Court and assisted us throughout our site visit. People living at Cosham Court told us the manager was friendly and approachable. Staff who responded to our survey were also positive, and comments included - I have learnt a lot in my year at the home and have had alot of support along the way. - The manager is very approachable and often checks I am happy in my job, and listens to anything I have to say. - Our manager supports us in our role. We interviewed four people visiting the home who told us the manager was very approachable, as well as staff members. Care Homes for Older People Page 24 of 29 We confirmed that the manager arranges for regular questionaires to be sent out to people living at Cosham Court and other stakeholders, as part of the homes quality assurance. The home returned the annual quality assurance questionaire in time and this told us many things about Cosham Court. We spoke to six people living at the home and all said they felt they were consulted about things that go on at Cosham Court. We checked a sample of peoples monies and valuables deposited with the home for safe keeping. We found there are monthly audits of these accounts/deposits and spot checks. Records of all valuables were in place and were found to be accurately maintained. There were records of any additional charges made in such areas as hairdressing, chiropody, newspapers and personal toiletries. There was also a record of travel tokens for one individual we checked and this balanced. We toured the premises and found no obvious hazards under health and safety visable. Care had been taken during the building works to promote the safety and welbeing of staff, visitors and residents. The area of the home where the works are being carried out was secure and two rooms had been decommissioned during the works. There were good infection control practices and procedures in place. Staff were receiving other health and safety related training in such areas as manual handling and moving, and this was regularly up dated. There are arrangements in place to ensure checks and servicing is provided in such areas as, premises electrical circuits, portable electrical equipment, lifts/stair lifts, hoists including portable, fire detection and alarm, fire fighting equipment, emergency lighting, emergency call equipment, heating system, soiled waste disposal, and gas appliances. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes No Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 29 19 All necessary staff checks including CRB must be completed prior to employment. 30/04/2008 Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 The registered person must ensure that care plans are developed to reflect the current needs of the service users and how they plan to meet those needs. So that you can ensure that the service users assessed needs are met appropriately The registered person must ensure that risk assessments in relation to specialist care and screening is available and records of these are maintained and care plans developed to support these needs. So that the service users needs are met appropriately at all times. The registered person must ensure that arrangements are in place for the safe management of medication at all times. 30/06/09 2 8 14 30/06/09 3 9 13 30/06/09 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of Care Homes for Older People Page 27 of 29 improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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