Inspection on 18/07/05 for Cote House

This inspection was carried out on 18th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cote House 04/09/07

Cote House 31/08/06

Cote House 29/11/05

Cote House 08/02/05

Cote House 05/07/04

Cote House 27/01/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 Cote House Rowden Hill Chippenham Wiltshire SN15 2AG Lead Inspector Stephen Cousins Unannounced 18th July 2005 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. Cote House DD51_D01_S15901_COTEHOUSE_V231114_180705_STAGE4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cote House Address Rowden Hill Chippenham Wiltshire SN15 2AG 01249 653760 01249 653888 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) Milbury Care Services Limited Mrs Jennifer Boyne-Aitken Care Home 11 Category(ies) of PD Physical disability registration, with number of places Cote House DD51_D01_S15901_COTEHOUSE_V231114_180705_STAGE4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: No more than 10 persons in receipt of day care at any one time Date of last inspection 8 February 2005 Brief Description of the Service: Cote House provides care with nursing, and accommodation, for 11 people with physical disability. Service users may be adults between the ages of 18 and 65 years. The home offers long-term, short-term, and convalescent care. There are also up to 4 day care places.The service is operated by Milbury Care Services. This is a national private sector organisation, which is best known for its work in the learning disability field. Cote House is situated in a residential area, within easy reach of the centre of Chippenham. Accommodation is offered on the ground and first floors. All rooms have ceiling tracks for hoists. Wash hand basins are in all 11 single bedrooms, but only one room has an en suite bath. Bedrooms are available to accommodate wheelchair users and there is a passenger lift. -Because the home is registered to provide nursing care, a qualified nurse is on duty at all times, supported by a team of carers.. Cote House DD51_D01_S15901_COTEHOUSE_V231114_180705_STAGE4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 9.14am and 5.00pm. There were ten service users resident in the home. The findings from this inspection are based on a tour of the premises, speaking to service users, the manager and staff, and inspecting a number of records, including care plans. The inspector then met with Jenny Boyne- Aitken, the registered manager, to report the findings of the inspection. What the service does well: What has improved since the last inspection? What they could do better: The garden could be improved to make it more attractive and accessible to service users. The ramps and handrails leading to the garden required urgent work to make them safe and requests for maintenance and repairs need to be responded to quicker than they currently are. Formal supervision of staff needs to happen more frequently and staff meetings should be recorded. There needs to be a clearer way of recording recruitment checks on staff and, although there are systems in place for handling residents money, recording practice could be improved. Cote House DD51_D01_S15901_COTEHOUSE_V231114_180705_STAGE4.doc Version 1.30 Page 6 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. Cote House DD51_D01_S15901_COTEHOUSE_V231114_180705_STAGE4.doc Version 1.30 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 Cote House DD51_D01_S15901_COTEHOUSE_V231114_180705_STAGE4.doc Version 1.30 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) 1,2 and 3 Prospective service users have the information and the opportunity to make an informed choice about living at Cote House and the home is able to meet their needs and aspirations as far as is possible. EVIDENCE: A statement of purpose has been produced. The service users guide reflects the service provided and a small information leaflet is also available. Potential service users also have the opportunity for trial visits and stays if required. A new service user confirmed he had visited the home prior to moving in. Care plans contained pre admission assessment documents and the one for a recently admitted service users was particularly comprehensive. A pre admission assessment was available for a service user who was due to be admitted on the day of the inspection. Pre admission assessments had been carried out by either the manager or her deputy. The home is equipped and suitable for people with physical disabilities who require nursing care, either on a long or short-term basis. Specialised equipment is in place, the staff demonstrated good awareness of service users needs and appropriate training is available. Social needs are also addressed. Cote House DD51_D01_S15901_COTEHOUSE_V231114_180705_STAGE4.doc Version 1.30 Page 9 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 and 9 Service users needs are reflected in care plans. They are able to make decisions about their lifestyle and receive support in maintaining independence as far as is possible. EVIDENCE: Service users care plans appeared to reflect assessed needs, contained appropriate risk assessments and were reviewed regularly. They clearly focussed on the service users perspective. Appropriate equipment was available to meet needs and interventions such as fluid/nutritional intake and regular weighing were undertaken and recorded as required. Service users are involved in the care planning process, which enables them to make decisions about what support they require and how they would like to live. On their request, a shower chair with a footrest had been provided for a service user who stays for respite care, to help them to be more independent. Service users who smoke are risk assessed and support provided to ensure they can do so in safety. A service user who had previously enjoyed painting was being supported in doing so. Service users are supported accessing services and activities outside the home Cote House DD51_D01_S15901_COTEHOUSE_V231114_180705_STAGE4.doc Version 1.30 Page 10 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) 14,16 and 17 Service users have the choice to engage in leisure activities, and their rights and responsibilities are respected. A healthy diet is offered and meals are enjoyed. EVIDENCE: An activity programme was displayed on a notice board and included in-house and external activity, such as bowling, buffet lunches and film sessions. Those service users who wished to partake commented that they enjoyed the activity provided. One service user commented that they were bored, however the staff and manager were aware of this and were endeavouring to address the situation. Personal home entertainment equipment was available in bedrooms and other entertainment equipment in the main lounge. Service users’ wishes are respected regarding how they want to live and be supported. This includes choices such as times for going to bed or getting up; and when to take a bath. Day and night profiles are compiled, showing the usual routine preferred by each person as part of their care plans. There were positive comments regarding the meals provided. There are a variety of choices from the menu available throughout the day and meals are Cote House DD51_D01_S15901_COTEHOUSE_V231114_180705_STAGE4.doc Version 1.30 Page 11 prepared in a domestic style kitchen by the care workers. There is a separate dining area, however service users can choose where they wish to eat. A range of dietary needs can be catered for, including specialised feeding regimes Cote House DD51_D01_S15901_COTEHOUSE_V231114_180705_STAGE4.doc Version 1.30 Page 12 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) 18,19 and 20 Support is provided the way service users prefer, and physical and emotional health needs appear to be met. The arrangements for handling medications protect the service users. EVIDENCE: The service users spoken with were positive about the support provided. One stated ‘I’m well looked after, I get plenty to drink’. Another said ‘It’s good here they are nice people’ and another attending for a respite stay ‘they look after me while I’m here, I don’t mind coming here at all’. A fully dependant service user was receiving appropriate support, their personal hygiene needs were being met; they appeared well hydrated and nourished. There were no service users with pressure sores. A physiotherapist attends the home weekly and a physiotherapy assistant is employed. All service users were registered with a local GP surgery. Care plans also showed evidence that health and emotional issues were dealt with promptly and other health care professionals were involved where necessary. The arrangements for dealing with medicines were found to be satisfactory, however not all hand written amendments of additions had two signatures. Arrangements for the disposal of medicines were being put in place now that they were unable to be returned to the issuing pharmacy. There were no current service users who were self medicating. Cote House DD51_D01_S15901_COTEHOUSE_V231114_180705_STAGE4.doc Version 1.30 Page 13 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 and 23 Service users views are listened to and acted on and, as far as possible, they are protected from abuse, neglect and self harm. EVIDENCE: A complaints procedure was available, along with large print and abridged versions; these were also contained in the service users guide. Slight amendment is required as the documents refer to NCSC and not CSCI. No formal complaints had been received, either by the home or CSCI since the previous inspection. There were no complaints from service users during the inspection, apart from one person saying they were bored; one said that they would approach the manager, another the nurse in charge, if they had any complaints. The manager was aware of the individual complaint of boredom and was able to demonstrate how it was being addressed. They was awareness amongst staff regarding procedures for the protection of vulnerable adults and a booklet containing local guidelines had been given out. CRB/POVA checks had been carried out on all staff and abuse awareness training was available and also included within NVQ. A ‘whistle blowing’ policy is available for staff to report any concerns about practices in the home. Risk assessments are in place with regard to the possibility of self-harm, such as unsupervised smoking or leaving the home without an escort. The arrangements for the safekeeping of residents’ money were reviewed and found to be satisfactory and regularly checked, however care needs to be taken to record transactions promptly to ensure balances are correct at all times. Cote House DD51_D01_S15901_COTEHOUSE_V231114_180705_STAGE4.doc Version 1.30 Page 14 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) 24,27,28,29 and 30. Internally the home is comfortable, clean and safe and has good communal space. There are adequate toilet and bathing facilities and equipment is available to maximise independence. External areas require improvement with some areas currently compromising service users and staff safety. EVIDENCE: The home is a large converted Victorian house. The manager reported that there was a programme of internal decoration and that all external windows were due to be replaced. Communal rooms include a sitting room, dining room and conservatory, all were well decorated and the furniture and fittings domestic in style and in good order. As reported at the last inspection, there is a large garden to the rear of the home that could be greatly improved to the benefit of service users, particularly with regard to appearance and accessibility. The handrails alongside pathways were unsafe and brickwork in a poor state. This had been reported by the manager but repair had yet to be undertaken. An immediate requirement was issued to ensure the safety of service users and to complete repair work by the 8th August 2005. The manager has subsequently confirmed Cote House DD51_D01_S15901_COTEHOUSE_V231114_180705_STAGE4.doc Version 1.30 Page 15 that, due to a delay in supply of appropriate materials, work was now due to commence on the 8th August 2005. There were concerns from staff about lack of space for the provision of personal care for day care service users, when there is not an empty bedroom available. This was discussed with the manager who stated that plans were in place to use the clinical room for this purpose. There are two toilets, one bathroom and one shower room on the ground floor and a bathroom and toilet on the first floor; all are suitable for use by people with physical disability. One bedroom has an en-suite bathroom. Ceiling hoists are available in all toilets and bathrooms. Grab rails are also fitted. Both baths for general use are of an adapted design. Specialised seating, wheelchairs and beds to suit the needs of the service users are in use. All main doors have wheelchair access. There is a lift to the first floor. Some service users have system, which enable them to control various aspects of their environment with minimal movement. A number of ceiling hoists throughout the building have been replaced. The home was clean and free from unpleasant odours. Infection control procedures were in place. The laundry was clean and tidy but there were no disposable gloves or aprons available in there at the time of the inspection. Cote House DD51_D01_S15901_COTEHOUSE_V231114_180705_STAGE4.doc Version 1.30 Page 16 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) 33,34 and 36 There is enough staff to support the service users and the recruitment practice protects them. Formal supervision of staff is sporadic and could be improved. EVIDENCE: There were three registered nurses’; three care assistants and a cleaner on duty. One care staff member was allocated to support the day care users. Two waking staff provide overnight cover, one of whom is a nurse. Staff spoken to felt levels were sufficient but the manager said there was a need to recruit more permanent staff and was currently doing so. Service users felt there were enough staff in the home. Duty rota’s showed adherence to the minimum staffing notice, along with some use of agency staff. Staff training was available but not fully assessed as training records were not in the home at the time of the inspection Review of staff recruitment files indicated that recruitment procedure was generally satisfactory and appears non discriminatory. Identification documents were in place, as was evidence of CRB/POVA checks. In one case only part of a CRB certificate was available meaning it was not possible to know the date when the CRB was obtained, nor the CRB/POVA status. The process was administered by Milbury Care head office and the assumption was that the CRB/POVA was ‘clear’. The CRB status of the person was then verified. Cote House DD51_D01_S15901_COTEHOUSE_V231114_180705_STAGE4.doc Version 1.30 Page 17 Day to day supervision of staff appeared satisfactory and there were some records of formal staff supervision. However, the manager stated that it was proving difficult to achieve the required six times a year for all staff. Other methods of achieving this were discussed. The manager stated that staff meetings were held every two months but records were not available for any recent meeting. Cote House DD51_D01_S15901_COTEHOUSE_V231114_180705_STAGE4.doc Version 1.30 Page 18 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 and 42 The service users are consulted about their views on the service and there are good quality assurance systems. The health, safety and welfare of service users are promoted. EVIDENCE: The registered providers undertake monthly audits, part of which involves interviews with service users and staff. Service user meetings were not routinely held but communication between the manager, staff and the residents appeared open and good. Accidents were recorded and reviewed. There was evidence that action had been taken to lessen risk if required. There had been no major accidents and no referrals to hospital due to accidents. Thermostatic control valves are fitted to hot water outlets and temperatures are regularly checked. Radiators are covered. Food hygiene and infection control procedures are carried out. Ceiling hoists are available throughout the Cote House DD51_D01_S15901_COTEHOUSE_V231114_180705_STAGE4.doc Version 1.30 Page 19 home, a manual handling trainer is in place and training is ongoing. The fire log indicated that fire safety tests were carried out at the required intervals. A monthly health and safety audit is carried out. The maintenance record indicated that gas, water and electrical safety tests had been carried out. Lifting equipment had been serviced. Routine checks of hot water temperatures and the call bell system were also recorded. Cote House DD51_D01_S15901_COTEHOUSE_V231114_180705_STAGE4.doc Version 1.30 Page 20 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. 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 3 3 3 x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x 3 3 3 3 Standard No 11 12 13 14 15 16 17 x x x 3 x 3 3 Standard No 31 32 33 34 35 36 Score x x 3 3 x 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cote House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 3 x DD51_D01_S15901_COTEHOUSE_V231114_180705_STAGE4.doc Version 1.30 Page 21 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 YA42 Regulation 13(4,a) Requirement The registered provider is required to ensure that immediate action is taken with regard to the safety of service users in relation to the condition of the hand rails in the garden area. Immediate requirement notice issued 18/7/05 The registered provider is required to ensure that any repair work to the handrails be completed by 8/8/05. Immediate requirement notice issued 18/7/05 Immediate requirement unmet. Timescale for action extended The registered provider is required to ensure that any repairs or maintenance needed, that may affect the health and safety of service users or staff, be carried out promptly.. The registered manager is required to ensure that disposable aprons and gloves are available in the laundry at all times. The registered manager is required to ensure that staff have regular, recorded Timescale for action 18/7/05 2. YA42 13(4,a) 22/8/05 3. YA24 13(4,a) 18/7/05 4. YA30 13(4,a) 16(2,j) 18/7/05 5. YA36 18(2) 18/7/05. Cote House DD51_D01_S15901_COTEHOUSE_V231114_180705_STAGE4.doc Version 1.30 Page 22 supervision meetings at least six times a year. 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. 5. Refer to Standard YA20 YA23 YA24 YA33 YA36 Good Practice Recommendations It is recommended that any handwritten amendments or additions to MAR sheets be witnessed and signed by two people With regard to the control of service users money. It is recommended that all transactions be recorded promptly to ensure that remaining balances are correct. It is recommended that further work be carried out on the garden area in order to improve accessibility and enhance the external environment for service uers. It is recommended that the current system of recording CRB results be reviewed. It is recommended that staff meetings are recorded and that the record be made available to staff. Cote House DD51_D01_S15901_COTEHOUSE_V231114_180705_STAGE4.doc Version 1.30 Page 23 Commission for Social Care Inspection Suite C, Avonbridge House Bath Road, Chippenham Wiltshire SN15 2BB 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 Cote House DD51_D01_S15901_COTEHOUSE_V231114_180705_STAGE4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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