Inspection on 20/11/06 for Cossins House Care Home

This inspection was carried out on 20th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Cossins House Care Home 31/07/08

Cossins House Care Home 18/07/07

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

CARE HOMES FOR OLDER PEOPLE Cossins House Care Home Cossins House Care Home 1 Downside Road Downside Cobham Surrey KT11 3LZ Lead Inspector Vera Bulbeck Unannounced Inspection 20th November 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cossins House Care Home DS0000068393.V320501.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. Cossins House Care Home DS0000068393.V320501.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cossins House Care Home Address Cossins House Care Home 1 Downside Road Downside Cobham Surrey KT11 3LZ 01932 862038 01932 863497 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) Grandcross Limited (wholly owned subsidiary of Four Seasons Health Care Ltd) Mrs Carol Patricia Kirby Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Cossins House Care Home DS0000068393.V320501.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26/01/06 Brief Description of the Service: Cossins House is registered to provide residential care for up to twenty- four service users within the category of older people. Many of the service users are able to care for themselves with only minimal assistance. Accommodation for service users consists of eighteen single bedrooms, with an additional three double bedrooms being provided in bungalows situated in the grounds for service users who are more independent. All bedrooms are ample in size and all but one bedroom have en-suite facilities. Access to the first floor is via a passenger lift. The communal areas are spacious and have recently been refurbished with most rooms providing pleasant views of the gardens and surrounding area. The home is situated in the village of Cobham, which provides good transport links, shopping facilities and a local church. Car parking is provided at the front and side of the home. Cossins House Care Home DS0000068393.V320501.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first site visit to be undertaken by the Commission for Social Care Inspection for the year April 2006 to March 2007. The site visit was over a period of eight hours. For details of how each standard was met please refer to the main body of the report. The site visit was unannounced, which meant that visitors, staff and residents were not aware of the visit prior to it commencing. The inspector had the opportunity to speak with a number of residents who live at the home. The majority were very complimentary about the home and staff. A full tour of the premises was undertaken. Four care plans were observed. There were three members of staff on duty and the registered manager. All members of staff were spoken with during the visit. Nineteen residents were in the home at the time of arrival. The majority of residents were spoken to on the day of the site visit. One resident informed the inspector, she has lived in the home for a number of years (20) and has been very happy during this time. Two relatives were spoken to during the day, both expressed they were happy with the care provided in the home, and felt their relatives were happy and contented with their surroundings. A number of comment cards were left for residents and relatives to complete and requested they be returned to Commission for Social Care Inspection (CSCI) Eashing Office. Ten feedback comment cards have been received since the inspection, residents completed four and six were completed with support by a relative. Positive comments were received by the majority for example “Staff are caring and helpful” and another comment stated, “One would be hard pressed to find a better home”. However, the food seems to be high on the resident’s agenda with a number stating the food could be improved. Too much mince, meatballs and sausages. Mrs V Bulbeck, Lead Inspector for the service carried out the site visit. Mrs Carol Kirby the Registered Manager of the home was present. The home is registered for twenty-four places. There are currently nineteen residents living in the home. The range of fees for the home is from: £695.00 - £760.00. Cossins House Care Home DS0000068393.V320501.R01.S.doc Version 5.2 Page 6 The staff was observed to be courteous and the atmosphere within the home was relaxed and friendly. The inspector would like to thank the residents and staff for their co-operation and hospitality during the inspection. The residents living in the home wish to be called residents, therefore service users will be referred to as residents throughout the report. What the service does well: What has improved since the last inspection? It was difficult for the inspector to evaluate any improvements to the home due to the fact that this was the first visit to Cossins House by the inspector; therefore it was difficult to make a judgement. The registered manager informed the inspector that one of the cottages has had a new carpet and new floor covering in the kitchen and bathroom. Another resident in another cottage refused to have any improvements undertaken. The dining room was to be fitted with a new carpet the following day after the inspection, arrangements were being put in place for all the residents to have their meals served in their bedrooms while the carpet laying was being undertaken. All vacant bedrooms are newly decorated for perspective new residents. The home had a complete refurbishment two years ago. The office has undergone a new filing system. Cossins House Care Home DS0000068393.V320501.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Cossins House Care Home DS0000068393.V320501.R01.S.doc Version 5.2 Page 8 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 Cossins House Care Home DS0000068393.V320501.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each resident is only admitted to the home following a needs assessment to ensure that the home can meet the resident’s identified needs. The home does not offer intermediate care. EVIDENCE: At the time of the visit it was noted that a resident had recently visited the home for a pre assessment, this was undertaken with the resident and a relative and management of the home to ensure the home is able to meet the residents needs, prior to admission to the home. The management of the home needs to ensure the statement of purpose and the service users guide is updated on a regular basis and a copy should be provided to all residents, and relatives need to be provided with a copy particuarly, if a resident is unable to be involved with the care provided in the home. Cossins House Care Home DS0000068393.V320501.R01.S.doc Version 5.2 Page 10 The home does not offer intermediate care. Cossins House Care Home DS0000068393.V320501.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Personal care and healthcare support and assistance is planned and was seen to be provided, where needed, in a respectful and sensitive manner. Policies, procedures and practices are in place. EVIDENCE: Four residents care plans were sampled and there was evidence that resident’s health, personal and social care needs had been identified and assessed. A number of documents in the care plan need to be signed and updated for all residents living in the home. Resident’s needs relate to equality and diversity. It was identified at the time of the visit that some staff have received training for equality and diversity; all staff need to attend equality and diversity training. The residents spoken to confirmed that staff are respectful and knock on the door before entering. Observation by the inspector was residents and staff Cossins House Care Home DS0000068393.V320501.R01.S.doc Version 5.2 Page 12 have a good rapport, residents are able to discuss with the staff any worries they may have and staff reassure residents, by supporting, explaining, and helping to clarify any problems and to ensure residents have a clear understanding. A key worker system is in place. Medication records were found to be well documented. However, it was noted that some resident’s take homely remedies. The inspector advised the manager to check with the doctor if the homely remedies were appropriate to be taken with the medication already prescribed by the G.P. The registered manger informed the inspector, that the doctor refused to update and sign a declaration. The health centre has commented this is recourses based and has written to management of the home to request a retainer fee for services provided. Storage facilities for medication were appropriate. Medication is administered from blister packs and two members of staff are involved with the process. The hairdresser was present in the home on the day of the site visit; she stated she visits on a regular basis and has been working in the home for a number of years and knows all the residents well. She also brings her two dogs for the residents to see and make a fuss of. The hairdresser stated that residents discuss with her about how happy they are living in the home, she informed the inspector that she has always received good feedback from the residents. Cossins House Care Home DS0000068393.V320501.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported and encouraged to maintain contact with family and friends. Menus need to be adhered to, record keeping needs to improve with individual choices and preferences as well as special dietary needs catered for. EVIDENCE: There is a need to expand the activities in the home. A number of comments from residents stated there is not enough to do. The registered manager informed the inspector that when organised events take place, residents are reluctant to join in. However, during the better weather residents are taken out to various places one place for example is a garden centre and they have afternoon tea while there. The inspector was able to speak with the majority of residents living in the home and all confirmed they are happy with their bedroom and most of the staff are kind, one resident commented “they do not always have enough time to talk to the residents as they have too much to do, and sometimes they are short of staff”. Cossins House Care Home DS0000068393.V320501.R01.S.doc Version 5.2 Page 14 The residents seem to spend a lot of their time in their bedrooms only coming down to the dining room for meals. A number of residents have their meals in their bedrooms. However, the majority of residents seem to enjoy chatting in the dining room while waiting for meal times. All appeared to be happy and those spoken to confirmed they were happy to be living in the home, and one resident stated the staff are very nice and helpful. The Majority of residents have contact with family and friends. The inspector advised the home to contact Age Concern regarding obtaining an Advocate for any residents without family contact. Residents are encouraged to vote and some have been registered for a postal vote. A number of residents commented on the food served in the home was “not so good”, to much mince, meatballs and sausages. The 4 weekly menus were not being adhered to. The records seen on the day of inspection were not dated and recorded on loose pieces of paper. These need to be filed appropriately, up to date records need to be maintained and should include dates and alternative meals. Choice of meals needs to be expanded. The nutritional content and balancing of the meals needs to be discussed with a dietician, to ensure residents are eating appropriately. Cossins House Care Home DS0000068393.V320501.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a simple, clear and accessible complaints procedure, which includes timescales for the process. All required policies and procedures are in place to ensure that residents are safeguarded from harm or abuse. EVIDENCE: There have been no recorded complaints in the home since 23/02/06. However, there were no details of the complaint on the day of inspection. The registered manager confirmed that the complaint had been dealt with, and within the timescales. The home has developed its complaints procedure and a copy is available in each resident’s bedroom. A relative confirmed that he would know how to access the complaints procedure if required and clarified he has in the past spoken to management of the home and his concern/complaint has been dealt with appropriately. The homes policies and procedures for the protection of vulnerable adults and a whistle blowing policy were in place and all staff except a new member of staff has received the protection of vulnerable adults training. Staff on duty confirmed they had undertaken this training and were aware of the procedures. The home has a copy of Surrey Multi Agency procedures. Cossins House Care Home DS0000068393.V320501.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The location and layout of the home is situated in a very rural part of Cobham village. An ongoing maintenance and redecoration programme provides the residents with clean, pleasant and homely surroundings in which to live. EVIDENCE: The grounds of the home are pleasant and during the summer months the inspector was informed that residents like to walk and sit in the garden. There is a path that residents are able to use to walk on in part of the garden. The gardens in the grounds of the home are vast and require considerable attention. The maintenance person looks after the garden as well as the interior of the home, he confirmed he enjoys working in the home and is conscientious about his work. The home was found to be clean and tidy, there are two domestics who work on a part time basis Monday to Friday and staff undertakes cleaning duties at Cossins House Care Home DS0000068393.V320501.R01.S.doc Version 5.2 Page 17 weekends. Some of the residents like to be involved with small cleaning jobs in their bedrooms. There are several areas around the home that have a nice homely touch and residents enjoy. It was noted that two of the bedrooms had a star lock; the inspector advised the registered manger to remove these particular locks. It was also noted in a residents bedroom that the resident likes to make hot drinks and has an electric kettle. The inspector would advise the management of the home to supply a safe area in the resident’s bedroom for the kettle to be used to eliminate any accidents. A risk assessment to be undertaken on the resident. It was also noted in another resident’s bedroom that there were two four-plug extension leads with trailing wires. This could be hazardous and needs to be reviewed and plugs need to be in a secure place. One of the bathrooms needs to have a paper towel and soap dispenser fitted. The communal areas of the home are nicely decorated and welcoming. However, the lounge is mainly used for activities, which are not undertaken on a regular basis. As on the day of inspection the only person seen in the lounge all day was a resident having her hair done. The windows frames on the cottages are very weathered and need painting or replacing. Cossins House Care Home DS0000068393.V320501.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 29. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of the staff meets resident’s needs. The home has a comprehensive staff recruitment and training programme which incorporates all areas needed to ensure, as far as reasonably possible, that residents are in safe hands at all times. EVIDENCE: There is a key worker system in place and the registered manager stated that if more staff is required to work at any time, for example when the homes vacancies are filled. At the present time there are adequate staff on duty during each shift, these include the registered manager or deputy manager, three care staff, administrator, domestic staff and the chef. A maintenance person, who works in the home on a daily basis, carries out all the maintenance jobs required in the home as well as the large grounds/gardens. Full recruitment procedures are being followed. All staff has been checked against the Criminal Records Bureau (CRB) before working in the home. Staff records were observed and found to be well documented, including contracts and terms and conditions. Training has been ongoing and the majority of staff has attended a number of training courses. A training plan has been produced and was up to date. All Cossins House Care Home DS0000068393.V320501.R01.S.doc Version 5.2 Page 19 new staff has a comprehensive induction-training programme. The majority of staff has received (POVA) protection of vulnerable adults training. A number of staff has completed NVQ Level 2, and some staff is in the process of completing. The deputy manager is in the process of completing NVQ Level 3. Training has been identified as a priority. Cossins House Care Home DS0000068393.V320501.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s, benefit from an open, positive and inclusive management style. The home has a monitoring system in place that is based on seeking the views of the residents. All policies, procedures and practices are in place to ensure as is reasonably practicable, the welfare, health and safety of residents and staff. EVIDENCE: The registered manager completed the Registered Managers Award three years ago and is competent, and experienced to manage the home. Cossins House Care Home DS0000068393.V320501.R01.S.doc Version 5.2 Page 21 A questionnaire (Customer Care Satisfaction) is sent to all relatives on a yearly basis and in August 2006 out of eighteen questionnaires sent out seven had been returned the majority stated they were satisfied with the care received and some comments were regarding the food, and there could be more activities and involvement with the local community. The registered manager informed the inspector, resident’s relatives manage their finances, the home does get involved with the resident’s finances, and the majority of residents have family who are involved. The administrator sends out invoices for any money paid by the home for residents. This is mainly for hairdressing, chiropody or other incidentals. At the time of the site visit it was noted that the Environmental Health Officer (EHO) undertook a visit on 22/03/06 and was awarded a Silver Food Award certificate, which is hanging in the entrance of the home. At the time of the visit the (EHO) made a requirement that the ceiling in the kitchen required attention, and a two-month time limit was stated. It was disappointing to note that on the day of the inspection the ceiling work had not been completed and was still outstanding. There is a regular monthly monitoring visit by Grandcross limited, subsidiary of Four Seasons Health Care Ltd Management. The reports were seen to be well recorded and all areas around the home are covered by the visit. A number of records were checked and the majority were found to be well documented. A system is in place in the home to record weekly, residents at risk. Accident/incidents are summarised on a weekly basis to ensure the management of the home has a clear picture of the numbers, times and dates of falls or incidents. It was observed in the accident book that all relevant accidents and incidents must be filed in the appropriate persons file and should not be left in the accident book this is a requirement from the Data Protection Act. Cossins House Care Home DS0000068393.V320501.R01.S.doc Version 5.2 Page 22 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 2 Cossins House Care Home DS0000068393.V320501.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3 4 Standard OP15 OP19 OP19 OP38 Regulation 17 13 13 13 Requirement Records for daily menus need to be improved. The kettle needs to be moved to a safe area. Extension lead plugs and trailing wires need attention. The EHO report needs attending to. Timescale for action 22/12/06 27/11/06 27/11/06 27/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP10 OP12 OP19 OP38 Good Practice Recommendations Residents meeting to be undertaken on a regular basis. The activity programme needs to be expanded. Star locks on two bedroom doors need to be removed. Some doors need to have a fire notice fitted. Cossins House Care Home DS0000068393.V320501.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 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 © 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 Cossins House Care Home DS0000068393.V320501.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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!