Inspection on 20/05/05 for Cossham Gardens

This inspection was carried out on 20th May 2005.

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

The inspector 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

Cossham Gardens 05/02/08

Cossham Gardens 16/05/06

Cossham Gardens 21/10/05

Cossham Gardens 12/11/04

Cossham Gardens 17/05/04

Similar services:

The Vicarage

7 Hyde Road

5 Seafield Road

Trevaylor Manor

12 Orchard Mews

Stallcombe House

Stepping Stones

Cornerstones

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

CARE HOME ADULTS 18-65 Cossham Gardens Lodge Road Kingswood South Glos BS15 1LE Lead Inspector Andrew Pollard Draft - Announced 20th May 2005 9:45 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Cossham Gardens Version 1.10 Page 3 SERVICE INFORMATION Name of service Cossham Gardens Address Lodge Road Kingswood South Glos BS15 1LE 0117 9673667 0117 9670849 cossham@swest.leonard-cheshire.org.uk Leonard Cheshire Foundation Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Juliette Nicola Marsden CRHN 16 Category(ies) of PD Physical disability,16 registration, with number of places Cossham Gardens Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Staffing Notice dated 29/03/2000 applies Manager must be a RN on parts 1 or 12 of the NMC register May accommodate persons aged 19 years and over only. Date of last inspection 12-Nov-2004 Brief Description of the Service: Cossham Gardens is registered as a Care Home with nursing for a maximum of 16 residents with profound disability, all of whom require nursing care.The Home is situated in Kingswood, behind Cossham Hospital and is set in its own grounds. The home is a purpose built property providing accommodation in 16 single en-suite rooms designed for people with physical disabilities. There is communal and activity space in 5 areas.It has easy access to local community facilities and is less than 1 mile from local shops and services and 4 miles to Bristol city centre. It can be accessed by car, or by bus with a short walk. There are also pleasant gardens to the rear and side of the property. All parts of the home are accessible to wheelchair users as well as the able-bodied. Cossham Gardens Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The following methods of evidence gathering have been used in the production of this report; observation, pre-inspection questionnaire, discussion with residents and staff, relative and residents comment cards, tour of the home and sampling policies, records, care plans, meals. The house was purpose built for disabled people and is generally well designed for the function. It is well furnished and equipped to a high standard. The house is considered a home for life and all physical health care needs would be met including terminal care. The home is an open, well-managed and friendly establishment and has a pleasant relaxed atmosphere. There are a small number of recommendations set out in this report, which were discussed during the inspection but the standards overall are high. The inspector was only able to verbally communicate with a few residents and spoke with some members of staff. The staff felt well supported and considered morale to be high. Residents appeared content and well cared for. Comments received were complimentary of the home in general Care is individualised and where appropriate the multidisciplinary approach is used to maintain, enhance and develop independence and skills. What the service does well: What has improved since the last inspection? Providing training for all grades of staff with regard to protection of vulnerable adults. The provision of Physiotherapy and activity organiser’s services. Cossham Gardens Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cossham Gardens Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Cossham Gardens Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,3,4 Thorough assessment of prospective residents needs is carried out. Trial visits and longer stays give prospective residents an opportunity to assess the nature of the home. EVIDENCE: Cossham Gardens Version 1.10 Page 9 10 of the residents are under the care of the local PCT. The remainder are placed by Social Services. Both authorities supply assessment documents. Two recent admissions had arrived with comprehensive assessment documentation and other care records. The manager or other senior first level nursing staff carry out any pre admission assessment, using comprehensive holistic pre admission assessment documentation which was properly completed. Room choice is generally limited to one as vacancies arise, however the rooms are similar in layout and size. Potential residents are invited to visit the home. Viewings are normally undertaken in the company of a relative or social worker. Prospective residents are invited for a meal and to meet other residents leading to an overnight stay and longer if required or practical. These visits are arranged for the home to assess if needs can be met and if the home is suitable for the prospective resident and whether they wish to move in. The staff seek the views of residents already living in the home who were able to express an opinion. The outcomes of the NHS and Social Services care reviews demonstrate the home’s ability to meet needs. A formal three-month trial is followed by a full review. No emergency admissions are accepted. Cossham Gardens Version 1.10 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,10 The care plans identify needs and give clear directions to staff. Residents or their advocates are consulted with about care matters and decisions about the way the home operates. Risk assessments are clear and detailed. Confidentiality of information is maintained. EVIDENCE: A named Registered Nurse is responsible for planning and reviewing care for residents with the Care Assistant (CA) key worker and other professionals where need be. Care planning documentation and evaluating of care plans were detailed and up to date. Where possible residents or relatives sign consents and care plans. Residents also sign to give consent for staff to discuss service provision and indicate gender preferences of staff giving personal care. The model of care is based on the activities of daily living. There are individualised risk assessments in case files Waterlow and Sterling index assessments are carried out for pressure risk assessment and dependency. Cossham Gardens Version 1.10 Page 11 All residents have Barthel dependency and continence assessments. There were resident risk assessments for moving and handling, to measure pressure sore development risk, falls risk and nutritional risk. Specialist equipment needs are recorded in the care plan. The nature of many of the resident’s disabilities means that meaningful participation in the running of the home is limited by their ability to communicate; therefore relationship building with staff is vital. The involvement of residents in decision-making relies heavily on these relationships and non-verbal communication or recognition of behaviours. Many relatives take an advocacy role on behalf of residents. The two comment cards received indicated relatives were consulted and kept informed. The organisation has Data Protection registration and a copy of the certificate was seen. The home has a confidentiality policy. Case files and records are stored securely. Cossham Gardens Version 1.10 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,14,15,17 It was evident from the range of social and occupational activities taking place that the staff strive to enhance the quality of life for the residents. Resident’s families are involved and informed of issues related to their relatives. From speaking to residents and reviewing records it was evident that the food provided is to peoples liking and offers a healthy diet. EVIDENCE: Cossham Gardens Version 1.10 Page 13 There are two adapted vehicles and two cars personally owned by residents. Residents require one to one or two to one support to go out of the home sometimes in the company of staff or relatives. Three residents attend dance voice and eight go to hydrotherapy. An activities organiser and volunteer’s co-ordinator works 35 hours per week. There is in addition a part time activity worker for 16 hours a week. Activities are targeted to individuals and require mostly one to one work. Some group activities are undertaken such as craftwork, cooking and use of computers trips out and holidays. The home has a well equipped activities and multi-sensory room. The majority of residents have strong family ties and their relatives are actively involved with the home. The resident’s forum isn’t operating. It is hoped that the role of the disabled peoples forum can be developed soon. Local clergymen arrange services and make pastoral visits and attends to residents spiritual needs. There are no residents from other faith backgrounds. It is hoped that the role of volunteers will be developed in the future. The majority of residents need to be fed and 6 have peg feeds. A dietician supports the staff and provides advice. All residents have feed programmes. The cook has previously carried out a survey of resident likes and dislikes and plans a weekly menu. Daily choices of food are established and alternatives are always available. The menu was varied and offered a balanced diet. None of the residents have special cultural dietary needs. One person requires a mainly vegetarian diet and one a diabetic diet. The home has previously won a good food commendation. It is intended that the cook when she has completed the appropriate qualifications will teach basic food hygiene to the staff. Cossham Gardens Version 1.10 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20 There are good arrangements in place to provide health care to the residents. Proper and safe procedures are in place to manage store and administer medication. EVIDENCE: Cossham Gardens Version 1.10 Page 15 Residents previously cared for via an NHS contract are now managed through the local PCT. The house is considered a home for life and all physical health care needs can be met including terminal care. The manager has training and experience in managing terminal care. Primary care services are provided for all residents by the Lodge side practice. A doctor will visit the home every Tuesday or as required. Where practical some residents will be escorted to the surgery for appointments. All residents require staff support to access primary care services. Respite care residents can be registered as temporary residents during their stay. The physiotherapist function is being filled by session work of approximately 10 hours per week. There is a physiotherapy assistant working 18 hours per week. Chiropody, speech therapy, dental and OT services are accessed when needed. Various other staff are working in the home such as private physiotherapists, aroma therapist and OT’s. Ms Marsden has clarified lines of accountability and insurance arrangements for all these staff all of which have had CRB checks. Registered Nurses have responsibility for the management of medication. None of the residents are able to self medicate. The home has recently changed its medication system to a monitored dose system. The supplying pharmacist has provided staff training and more indepth training for RN’s is planned. A medication policy and procedure and risk assessment system is in place although will need amending to take account of the new dispensing arrangements. The receipt and disposal records were in order. Controlled drugs records and storage arrangements were in order. Temperature recordings for the drug’s fridge are monitored and recorded daily. There are two suction machines, one of which is portable. There are ridged catheters available for these machines. Cossham Gardens Version 1.10 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 The complaint and POVA policies are clear and detailed. The staff are aware of the complaints and POVA policies and are trained in putting them into practice to protect residents from abuse. EVIDENCE: There have been no complaints since the last inspection. Relative and GP comment cards all indicated awareness of the complaint procedure and stated they had no complaints. The inspector has previously viewed the complaint procedure, which is a comprehensive document. The policy makes reference to CSCI as is required. There are alternative simplified and tape formats available for resident use. A detailed log of complaints and their outcomes is kept which was seen at the last inspection. Full details of complaints, actions and outcomes have been recorded. The home has written procedures for adult protection, whistle blowing, management of aggression, abuse, bullying and management of resident’s money/valuables. The home’s POVA statement gives a clear process to be followed. The DOH ‘No Secrets’ document was available and the Local Authority version. All staff have completed POVA update training and it is part of staff induction programmes. The manager has recently completed and trainers course in POVA issues. All staff receive training related to the protection of vulnerable adults and managing difficult behaviour when appropriate. All staff have been issued with the GSCC code of practice. Cossham Gardens Version 1.10 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,29,30 The house is a clean, comfortable and safe environment for the current residents. The bedrooms and communal rooms and facilities are suitable for their purpose and meet the resident’s needs. Residents have any specialist equipment they presently require to maintain and promote their independence. EVIDENCE: The house was purpose built for disabled people and is generally well designed for the function. The manager considers that the home is equipped to a sufficient level to meet all of the resident care needs and has sufficient fixed and mobile hoists. The manager recently placed an order for new beds and pressure relieving equipment. The home is well furnished to a high standard and the standard of décor is generally good however a couple of bedrooms are in need of redecoration and some ceramic tiles in bathrooms need replacement. All residents have single rooms with en-suite facilities. The bedrooms are well furnished with good quality items that are suitable to meet the resident’s needs and aid staff in the safe provision of physical care. Cossham Gardens Version 1.10 Page 18 All rooms have overhead tracking system to facilitate ease of movement between the room and bathroom. Some residents have an electronic door opening system and others can be fitted if residents are able to use them. Rooms evidence a great degree of personalisation. All four bathrooms and WC’s are large and suitable for disabled use and have a range of specialist baths and showers. All residents require staff support to use toilet and bathroom facilities. Two of the four separate communal areas are currently used as part dining rooms. There is one activity room and a sensory/multimedia room. The home was clean, tidy and in good order. The laundry facilities are suitable for personal laundry, bedding and towels. The kitchen was clean and in good order. The local EHO carried out an inspection in October. The food hazard analysis has been updated. Cossham Gardens Version 1.10 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,35 The staff are experienced and trained to meet the individual and joint needs of the residents. The staff skill mix and staffing levels are conducive to maintaining and enhancing the resident’s quality of life. The manager demonstrated a clear commitment to and focus on training. EVIDENCE: At least eight care staff and one RN works each morning, four plus one in the after noon and two plus one at night. The manager is supernumerary. Senior nurses are also given supernumerary time for planning and development. These staffing levels are in excess of the staffing notice requirements. Various staff are on special leave, which creates a demand for bank/ agency staff. All such staff have orientation and induction into the home. A new fulltime RN is to be recruited. In addition there are various therapists, activities staff and volunteers. There is a full and part time cook, 20 hours laundry staff and 28 hours domestic staff each week. A maintenance man /gardener has been recruited 21 hours per week. Training staff and admin staff are also employed. Cossham Gardens Version 1.10 Page 20 All new staff completes a detailed orientation and induction programme. The training co-ordinator has completed a training matrix and identified an annual training plan to ensure all staff receive / attend required training. The identification of learning needs is addressed through the appraisal and supervision process. There are 8 care staff on NVQ level 2 and 2 on level 3 programmes at present. The organisation has a comprehensive equal opportunities policy. The manager has completed the NVQ level 4 managers award. RN validations with the Nursing & Midwifery Council had been completed. The process for carrying out CRB and POVA checks for staff employed has been completed. The organisation’s head office supplies a list of satisfactory checks received to the manager. It was unclear what policy the organisation has for renewals of CRB’s. Cossham Gardens Version 1.10 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39,42 The staff are motivated to maitain and improve the residents quality of life. The staff seek to empower the residents and safeguard them from hazards. The home is a safe and well-maintained home. EVIDENCE: The organisation has a quality monitoring system linked to perfomance indicators A service review was recently conducted and a copy submitted to the commission, good progress is being made on implimenting the action plan. The self assessment tool based on the organisations standards requires input from the disabled peoples forum to be fully effective and the manager is trying to arrange this. All residents have contract reviews carried out by Social services, the NHS and multi disciplinary review. The organisation has Health and Safety policies and procedures and employs a Health and Safety Advisor. Ms Marsden has responsibility for health and safety within the home. There is a monthly H&S audit carried out and a quarterly H&S Cossham Gardens Version 1.10 Page 22 committee meets at the home. The boilers and hoist/bath equipment has been serviced. The fire log book was up to date and in order, training and drills have taken place. Hot water temperatures are monitored regularly. There is a system in place to manage the risk of legionella. PAT testing is regularly carried out. All staff receive mandatory training in load handling, first aid, fire safety, food hygiene and health and safety. The home has trained first aiders. Food hygiene training for staff is to be provided by the cook. SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 Cossham Gardens Score 3 3 x Standard No 24 25 26 27 28 29 30 Version 1.10 Score 2 3 x x x 3 3 Page 23 9 10 LIFESTYLES x 3 Score STAFFING Standard No 11 12 13 14 15 16 17 x 3 x 3 3 x 3 Standard No 31 32 33 34 35 36 Score x 2 3 x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 3 x Cossham Gardens Version 1.10 Page 24 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 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. 1. 2. 3. Refer to Standard 20 24 35 Good Practice Recommendations Update the medication policy to refect the new dispensing arrangements. Prepare a prioritised list of outstanding minor repairs and redecoration jobs for the new maintenance man to resolve. Determine a policy on renewals of CRB checks. Cossham Gardens Version 1.10 Page 25 Commission for Social Care Inspection 300 Aztec West Almondsbury South Gloucestershire BS32 4RG 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 Cossham Gardens Version 1.10 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!