Inspection on 31/08/06 for Cote House

This inspection was carried out on 31st August 2006.

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 found no outstanding requirements from the previous inspection report, but made 18 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 29/11/05

Cote House 18/07/05

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 Steve Cousins Key Unannounced Inspection 31 August – 8 September 2006 09:00 st th Cote House DS0000015901.V309855.R01.S.doc Version 5.2 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 Cote House DS0000015901.V309855.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 Adults 18-65. 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. Cote House DS0000015901.V309855.R01.S.doc Version 5.2 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 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) http/www.milburycare.com/home.html Milbury Care Services Limited Mrs Jennifer Boyne-Aitken Care Home 11 Category(ies) of Learning disability (2), Physical disability (11) registration, with number of places Cote House DS0000015901.V309855.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No more than 10 persons in receipt of day care at any one time No more than 2 persons with Learning Disabilities to be admitted to the home at any one time. 29th November 2005 Date of last inspection Brief Description of the Service: Cote House provides care with nursing for eleven people with physical disability. Service users are adults between the ages of 18 and 65 years. The home offers long-term, short-term, and convalescent care. There are also up to four day-care places per day. 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 eleven 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. 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. Fees are negotiable but the current lowest fee is £1100 per week. Cote House DS0000015901.V309855.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over the 31st of August 2006 and the 1st and 8th September 2006, in order to inspect all of the key minimum standards relating to care homes for adults aged 18 – 65. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the home and where possible, takes into account the views and experiences of people using the service. The findings from this inspection are based on several tours of the premises, speaking to service users and staff, and visiting frail service users. A number of records were inspected, including care plans, medication records and staff records. Comment cards were made available to residents’ relatives and representatives and the home’s GP following the inspection, however only one was returned (from a relative) prior to the completion of this report. The findings of the visit were discussed with Mrs Boyne-Aitken, the manager, at the end of the second day of the inspection. What the service does well: What has improved since the last inspection? What they could do better: Recent staff turnover has had an effect on the staff’s ability to maintain a good service, although recruitment is currently underway to try and remedy the situation. More support staff with NVQ qualifications would enhance the service Cote House DS0000015901.V309855.R01.S.doc Version 5.2 Page 6 provided and there is also a need to ensure new staff fully complete their induction training so they are equipped with the basic knowledge to support service users. Service users individual plans do not always reflect their needs in order to provide staff with all the information they need to support them and the review system is erratic. Nurses need to ensure that they record all the medications they administer and that service users are regularly weighed if required by assessment. Measures to ensure that service users attending physiotherapy sessions have their privacy and dignity respected need to be introduced and staff awareness of adult protection procedures needs to be enhanced. Some improvement is required with regard to choice and variety of meals and some service users feel more social activity is needed. The staff need to ensure that the kitchen, bathrooms and sluice are kept clean and hygienic to avoid any risk to residents and Milbury Care Services need to ensure that any repairs to equipment or the environment are carried out promptly, as this has inconvenienced service users and affected the staff’s ability to carry out their work. Communal areas could be improved by further redecoration and refurbishment and some health and safety checks and reviews need to be completed more regularly to avoid potential risks to residents and staff. 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 DS0000015901.V309855.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Cote House DS0000015901.V309855.R01.S.doc Version 5.2 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 the following standard(s): Standards 2 and 4 Prospective service users needs are assessed before admission and they have the opportunity to make an informed choice about living at Cote House. The quality in this outcome area is good. This judgement has been made from evidence gathered before, during and after the visit to this service. EVIDENCE: Service users records indicated that the manager or her deputy had undertaken pre admission assessments where possible. Those seen were generally comprehensive and involved the service user and their advocates. Where assessment by a representative of the home was not possible, then assessments from other suitable professionals were available. The inspector reviewed a pre admission assessment for a prospective service user, completed by the manager, who reported that the person had visited home and would be staying two nights per week initially, then gradually increasing following review. The manager had liaised with a community nurse about the person’s care and had requested documents from a previous placement. A current service user confirmed that they had the opportunity to visit the home before moving in. Cote House offers a respite and day care service, which also gives any potential service user the opportunity to ‘test-drive’ the home. Cote House DS0000015901.V309855.R01.S.doc Version 5.2 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 the following standard(s): Standards 6,7 and 9. Individual plans do not always reflect assessed needs and review systems are erratic. Where able, service users make decisions about their lifestyle and receive support in maintaining independence as far as is possible. The quality in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. EVIDENCE: The inspector chose six of the eleven service users currently in the home to case track. These were three females and three males between the ages of 34 and 65. They were a mixture of active and frail residents with varying physical and social needs, two were unable to verbally communicate and three had limited communication skills. All were dependant on staff to meet their health, personal and social care needs. The care plans of all those case tracked were reviewed and found to be of a varying standard. Some appeared an accurate reflection of assessed needs but others were not. In one case there were no plans in place for tissue viability, nutrition, mobilisation, personal hygiene, continence, communication or meeting social needs, however all had been highlighted as potential problems Cote House DS0000015901.V309855.R01.S.doc Version 5.2 Page 10 on assessment. Two further cases did not have care plans in place for tissue viability, yet both service users had been assessed as at risk. Pressure relief equipment had been provided in all cases. Care plans were reviewed at varying intervals but there appeared no set criteria for review. An entry on the front of one plan said ‘not for resuscitation/hospitalisation’ however there were no readily available documents that indicated that the decision had been made involving all appropriate parties and it had not been reviewed for some time. One service user who regularly attended for periods of respite had not had their plan fully reviewed on this admission, however a relative had provided comprehensive written information regarding current care needs. Although it is acknowledged that it was not possible for all service users, plans indicated that some were involved in the care planning process and had made decisions about what support they require and how they would like to live. Examples included having staff support them to access the community for social interaction and preferences for getting up or going to bed. One service user had moved to another room following a request and was also assisted to make visits to the family home. 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 drawing was being supported in doing so. Service users are supported accessing services and activities outside the home. Cote House DS0000015901.V309855.R01.S.doc Version 5.2 Page 11 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 the following standard(s): Standards 12,13, 14, 15, 16 and 17. There is a commitment to ensure service users have a choice to engage in social activities and they are supported to maintain links with family and friends. Some improvement is required with regard to choice and variety of meals and some service users feel more social activity is needed. The quality in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. EVIDENCE: Due to the nature of their disabilities, no current service users are in employment or attending further education or training. An activity-coordinator is employed and works 20 hours per week Tuesday to Friday. The coordinator said that, where possible, activities are based on individual’s capabilities. An activity record is kept and a programme displayed on a notice board and included in-house and external activity. Personal home entertainment equipment was available in bedrooms and other entertainment equipment in the main lounge. Cote House DS0000015901.V309855.R01.S.doc Version 5.2 Page 12 The activity co-ordinator and some service users confirmed that people are supported to retain links with family and friends. One service user was visiting their family home during the inspection and another had been supported to attend a family wedding. There are no restrictions on visiting and visitors were seen in the communal rooms and in service users rooms. Comments from service users and relatives included “There is enough to do, very nice”, “This is a nice place, nice people, everything is all right” and “My brother is very happy at Cote House”. A quality assurance questionnaire sent out to service users and relatives indicated overall satisfaction with daily life at Cote House, although one service user thought that there were ‘not enough activities’ and another commented to the inspector “it can get a bit boring at times”. Staff members were observed asking service users what they wanted to do and interacting with them when in communal areas. Some individual plans included information on 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. One service user said staff “do their best” to get him up when he wanted in the mornings. Service users opinion of the meals at Cote House appears divided. Two spoken to by the inspector felt the meals were good but others indicated on the home’s questionnaire that they felt there was a lack of choice and variety. Records of meals served in one week were reviewed, these indicated that a choice was available, but roast lamb appeared twice in four days and the choice at breakfast was limited. Cote House DS0000015901.V309855.R01.S.doc Version 5.2 Page 13 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 the following standard(s): Standards 18, 19 and 20 Staff deliver a satisfactory level of personal care and support and health care needs appear to be met, although those nutritionally at risk need to be regularly weighed. The recording of medication administration needs to be more robust to fully protect the service users. The quality in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. EVIDENCE: The inspector visited the service users who were ‘case tracked’ and found that equipment, aids and interventions were in place to meet their assessed needs. All appeared to be having their personal hygiene needs met. One frail service user who was nursed in bed for the majority of the inspection, was clean, comfortable and not in distress. A visitor to the home said that they always found the person they visited clean and as comfortable as possible and felt her care was good. A relative commented that that his relative in Cote House was “well looked after”. The homes questionnaire to service users and relatives indicated a general satisfaction with the support for personal care. Staff were observed engaging residents in conversation easily and also explaining what they were doing to residents with communication problems. Cote House DS0000015901.V309855.R01.S.doc Version 5.2 Page 14 Care records indicated that service users had access to their GP’s and other health care professionals and that staff responded promptly to any deterioration in health. Tissue viability and nutritional assessments were undertaken however some service users had not been weighed since May, despite being assessed as at risk. The manager stated that this was due to the weighing machine being out of order. A physiotherapist attends the home weekly. Service users receive physiotherapy in the main sitting room and up to six others were present whilst some received their therapy. There is some concern about how residents’ privacy and dignity is respected during these sessions, as screens are not used. There were no service users who self-medicated. The medicine trolley was secured and other medicines stored in locked cupboards. Records of receipts and returns were kept and there was a register for controlled drugs, although no service user was prescribed these at present. The medication fridge was at the right temperature and a record kept. The medication policy/procedure was dated 1/4/05 and the homely remedy policy for an individual service user was dated 22/4/05. Some medication administration record (MAR) sheets had gaps where staff had not signed for administration. In one case this included anticonvulsant drugs. A list of medication discrepancies indicated that 17 tablets had been found in various parts of the home between April and May 2006, which would indicate that staff were not witnessing medications were being taken. Only one further incident had been recorded since May, which indicates an improvement in this area. Cote House DS0000015901.V309855.R01.S.doc Version 5.2 Page 15 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 the following standard(s): Standards 22 and 23. A complaint system is in place, however none have been made directly to the home since the last inspection to enable a judgement to be made on how they are handled. As far as possible, service users appear protected from abuse and neglect, but staff training in abuse issues and awareness of reporting procedures could improve. The quality in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. EVIDENCE: A complaints procedure was available, along with large print and abridged versions; these were also contained in the service users guide. The home had not received any complaints since the previous inspection and none have been received by CSCI. A service user commented that they would “see the manager if I have any problems”. The findings of a questionnaire sent out to service users and relatives by the home confirmed that none had made any complaints. The comments of the service users indicated that they were well treated by the staff. A regular visitor stated that they had no concerns about the home and service users appeared comfortable when staff were around. There had been no referrals to or from the local Vulnerable Adults Unit regarding Cote House. Three members of staff spoken to by the inspector did not know the guidelines issued by the Local Authority for the reporting of suspected abuse and training records indicated that some staff had not received training in Cote House DS0000015901.V309855.R01.S.doc Version 5.2 Page 16 abuse issues since 1999. The arrangements for handling service users money were checked and found to be satisfactory. Cote House DS0000015901.V309855.R01.S.doc Version 5.2 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 the following standard(s): Standards 24 and 30. Improvement to the decoration and external areas of the home would enhance the environment for service users. Slow response from Milbury Care to requests for environmental and equipment repairs inconveniences service users and affects staff effectiveness. Cleanliness and hygiene practice was poor and put service users at risk, however this had improved by the final day of the inspection. The quality in this outcome area is poor. This judgement has been made from evidence gathered before, during and after the visit to this service. EVIDENCE: There were many comments from service users, staff and the manager that indicated problems regarding the overall environment and repairs to equipment. There was some frustration that repairs were not carried out quickly enough and staff felt that it reduced their effectiveness. The first floor bathroom had been out of action for some time, due to repairs needed to the bath, ceiling hoist and toilet. The ground floor bathroom required redecorating and the toilet seat replacing. The floor around toilet was stained and in poor condition. The main sitting room needed redecorating and the dining room had been partly redecorated but not finished. A handrail in a corridor had come away from the wall and a radiator cover was broken. Water was frequently Cote House DS0000015901.V309855.R01.S.doc Version 5.2 Page 18 overflowing from a pipe at the top of the building onto an external walkway. The area to the rear of the home had old paint pots, hoist tracking, broken shelving and bins, which had filled with rainwater. There was a further overflow pipe leaking by the conservatory. A receptacle to the front of the building used for storing linen prior to collection and after delivery, was overfilled and the door broken, leaving it open to the elements. There had been some improvements to the environment. Service users bedrooms had been fitted with new carpets and some new bedroom furniture had been purchased. The ramps and handrails to the rear of the home had been replaced and work had started on the construction of some raised beds in the garden. The manager stated that the home was due to be refurbished; however this had been reported at the previous inspection in November 2005. Service users bedrooms were generally clean and tidy but the standard of cleanliness in the kitchen, bathrooms and sluice room was poor and an Immediate Requirement notice was issued. The treatment room was untidy and the sink area required cleaning and de-scaling. Pressure relief mattresses were stored on an unused bed in the corner of the treatment room. Food hygiene practice required improvement as some foodstuffs in the fridge had not been marked with the date of opening and others had passed their ‘consume by’ date. These were removed during the inspection. The inspector toured the building with the deputy manager and the area manager to show them the areas of concern. The inspector returned to the home on the 8th September 2006 in order to review the action taken in response to the Immediate Requirement notice. The kitchen, bathroom and sluice areas had been thoroughly cleaned, the upper bathroom toilet repaired, one of the leaking overflow pipes had been fixed and a technician was on site to repair the bath hoist. The corridor handrail had been secured to the wall and the treatment room tidied and the sink cleaned. The external areas of the home had been cleared. Cote House DS0000015901.V309855.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 33, 34 and 35 Staff are presently under pressure to be able to fully meet service users needs but appear confident and effective in their roles. Improvement is required with regard to induction and NVQ training. Recruitment procedures protect the service users. The quality in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. EVIDENCE: The manager stated that there are currently eight nurses and fourteen support assistants employed at Cote House. Of the support workers two have an NVQ are two are currently completing. Mrs Boyne-Aitken was aware of the low level of support workers with NVQ and said that Milbury Care Services were currently rearranging their NVQ assessment centre and would start a further four support assistants on NVQ training in October. All service users and relatives who returned questionnaires replied ‘good’ or ‘excellent’ to the question ‘how do staff and service users get on?’ Throughout the inspection staff were accessible, communicated well and were approachable. Conversations with staff indicated they had an awareness of the needs of the service users. There was currently a period of instability with regard to staff turnover and staffing levels. The previous deputy manager, who had been at the home for Cote House DS0000015901.V309855.R01.S.doc Version 5.2 Page 20 many years, had moved on and a new deputy recently appointed. The manager was trying to recruit more nursing and support staff and in the meantime agency staff were being regularly used. The manager and all staff spoken to felt that the recent staff turnover had caused problems and the use of agency staff affected continuity and communication. One staff member felt that they (the staff) were meeting service users needs “by the skin of their teeth” and found it difficult to find time for “that personal touch”. They felt more staff were needed for the “morning rush” and at meal times. Another staff member felt they were “swimming against the tide at the moment” and that the problems with a bathroom and toilet being out of action had exacerbated this. However a resident said that “they seem to have enough staff and I don’t have to wait long for them to come if I need them” another felt staffing levels “are ok”. The recruitment documents of six staff were reviewed. POVA checks are obtained prior to commencing employment and CRB checks requested and obtained. Three of the staff only had one reference on file in the home. The manager stated that they were held at Milbury Care head office. The inspector requested that they be obtained, kept on file in the home and copies sent to the Commission. Two have been received prior to completion of this report and one is awaited. Other required documentation was in place. A selection of staff training records was reviewed. Individual training records are kept and the manager monitors mandatory training by use of a training matrix. A training programme was available which was hand written as the manager did not currently have access to a computer. A new member of staff confirmed that they had commenced induction training and had a mentor. She described other staff and manager as helpful and supportive. Other induction records seen were incomplete. Staff spoken to confirmed that they had received some training this year, such as POVA, wound care, resuscitation and palliative care study days and some had attended training on ‘non violent crisis intervention’ training. Cote House DS0000015901.V309855.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 and 42 The manager is qualified and competent to run the home and service users are consulted about their views on the service. Holding residents’ meetings may enhance this further. The health, safety and welfare of service users and staff is generally protected, however risk assessment reviews and some routine safety checks need to be more frequent. The quality in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. EVIDENCE: The registered manager is Mrs Jenny Boyne-Aitken. She is a first level general nurse who has the ENB 941 qualification in nursing elderly people. She is also a qualified NVQ assessor and internal verifier. Mrs Boyne –Aitken has been the manager of Cote House for over four years and is undertaking an NVQ Level 5 in management. Staff members spoken to say that Mrs Bowen-Aitken was approachable felt that she dealt well with any problems brought to her. The questionnaire received from service users and relatives’ contained good comments regarding the management of the home. Cote House DS0000015901.V309855.R01.S.doc Version 5.2 Page 22 Quality assurance systems consist of an annual questionnaire to service users and relatives and monthly visits by a representative of the registered providers, Milbury Care Services, during which individual service users are asked their views on the home. Reports of these visits are produced and sent to the manager and to CSCI. Service users meetings are not currently held. The manager reported that a satisfactory financial audit had been undertaken the previous month. The inspector reviewed the health and safety management arrangements in the home. General environmental risk assessments were in place but had not been recently reviewed. Hot water temperatures were checked monthly at all outlets and radiators were covered or had low temperature surfaces. Safety checks for wheelchairs and the homes vehicle were not always carried out weekly, as per the homes policy. The fire log indicated that the fire safety checks were carried out however alarms were not always checked on a weekly basis and the fire risk assessment required reviewing. Accidents are recorded and there had been none of a serious nature. The manager compiles a monthly accident return, which is sent to the Company’s regional office and then to a national health and safety director who decides if further action or investigation is required. The manager reported that no further investigations had been required this year. The pre inspection questionnaire received from the home indicates regular maintenance of essential services and equipment. Manual handling equipment is available and rooms are fitted with ceiling hoists. Records indicated and staff spoken with confirmed that they receive mandatory training in manual handling, infection control, food hygiene and first aid. Cote House DS0000015901.V309855.R01.S.doc Version 5.2 Page 23 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 Standard No Score 1 X 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 X 3 X X 2 X Cote House DS0000015901.V309855.R01.S.doc Version 5.2 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 YA6 Regulation 15 (1) Requirement The registered manager is required to ensure that individual plans are in place which reflect all of the service user’s assessed needs. The registered manager is required to ensure that service users individual plans are reviewed proportionate to assessed risk. The registered manager is required to ensure that physiotherapy sessions are conducted in a manner that respects service users privacy and dignity. The registered manager is required to ensure that service users assessed as nutritionally at risk are regularly weighed. The registered manager is required to ensure that nurses administering medication sign as having done so, or enter a code indicating the reason for omission. The registered manager is required to ensure that the medication policy and homely remedy policy are reviewed DS0000015901.V309855.R01.S.doc Timescale for action 22/09/06 2 YA6 15 (2,b,c) 08/09/06 3 YA18 12 (4,a) 08/09/06 4 YA19 14 (2,a) 08/09/06 5 YA20 13 (2) 17 (1,a) Schedule 3 (k) 13 (2) 08/09/06 6 YA20 01/10/06 Cote House Version 5.2 Page 25 7 YA24 23 (2,b) 8 YA24 23 (2,b) 9 YA24 13 (4,a,c) 23 (2,b) 10 YA24 23 (2,b) 11 YA30 13 (4,c) 12 YA30 13 (4,c) 13 YA34 (Schedule 2) 19 14 YA35 18 (1,a) 18 (c,i) 15 YA42 13 (4,a,c) The registered provider is required to ensure that the downstairs bathroom is redecorated and the flooring replaced. The registered provider is required to ensure that the redecoration of the dining room is completed. The registered provider is required to ensure that any repairs to equipment or the environment are carried out promptly The registered provider is required to ensure that the external laundry storage receptacle is repaired or replaced. The registered manager is required to ensure that the premises are kept clean and hygienic. (Immediate Requirement Notice issued relating to the kitchen, bathrooms and sluice.) Requirement met 08/09/06. The registered manager is required to ensure that all foodstuffs are marked with the date of opening and are disposed of once the ‘consume by’ date has been reached. The registered person is required to ensure that copies of staff references are held on file in the home. The registered manager is required to ensure that all newly recruited staff members complete induction training within twelve weeks. The registered manager is required to ensure that all environmental risk assessments are reviewed within the stated timescale and at least annually thereafter. DS0000015901.V309855.R01.S.doc 01/12/06 01/12/06 08/09/06 01/10/06 05/09/06 08/09/06 08/09/06 08/12/06 01/11/06 Cote House Version 5.2 Page 26 16 YA42 13 (4,b,c) 17 YA42 23 (4) 18 YA42 23 (4) The registered manager is required to ensure that safety checks of wheelchairs and vehicles are carried out as per the homes health and safety policy. The registered manager is required to ensure that the fire alarm system is checked weekly. The registered manager is required to ensure that the fire risk assessment is reviewed within the stated timescale and at least annually thereafter. 08/09/06 08/09/06 01/10/06 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 5 Refer to Standard YA12 YA17 YA23 YA23 YA24 Good Practice Recommendations It is recommended that a review of the activities available to service users be held to ensure individual needs are met. It is recommended that a review of the meals available be held to ensure that choice and variety is offered. It is recommended that staff receive training in adult protection. It is recommended that staff be informed of Local Authority guidelines relating to the reporting of suspected abuse. 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 users. (Recommendation carried over from previous inspection held 29/11/05 met in part) It is recommended that a review of current staffing levels and working practice be held to ensure staff are able to meet service users needs at all times of the day. It is recommended that service user meetings be held to enhance current quality assurance measures. 6 7 YA33 YA39 Cote House DS0000015901.V309855.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham 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 DS0000015901.V309855.R01.S.doc Version 5.2 Page 28 - 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. 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