Inspection on 05/12/08 for Cotleigh Care Home

This inspection was carried out on 5th December 2008.

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

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

Cotleigh Care Home 04/06/09

Cotleigh Care Home 15/08/07

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Cotleigh Care Home 31 Four Wells Drive Sheffield South Yorkshire S12 4JB Lead Inspector Ramchand Samachetty Key Unannounced Inspection 5th December 2008 09:30 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 Cotleigh Care Home DS0000069439.V373523.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. Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cotleigh Care Home Address 31 Four Wells Drive Sheffield South Yorkshire S12 4JB 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) 0114 263 3800 0114 263 3868 rod.macaskill@sheffcare.co.uk www.sheffcare.co.uk Sheffcare Limited Vacant Care Home 62 Category(ies) of Dementia (62), Old age, not falling within any registration, with number other category (62) of places Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC Service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 62 15th August 2007 Date of last inspection Brief Description of the Service: Cotleigh Care Home is a new purpose built care home operated by Sheffcare Ltd. It provides personal care for up to 62 older people, 30 of whom have dementia. The home provided its accommodation over two floors. There were passenger lifts and stairs to facilitate access between them. The first floor was used for older people and the ground floor for people with dementia. The doors on the ground floor were kept secure to prevent people with dementia from wandering from the building. There were lounges, dining rooms and small domestic kitchens on both floors. On the ground floor there is a café area, hairdressers and office reception area. All bedrooms were en-suite. Each floor had an assisted bathroom and ample communal space. There was a large, secure and accessible garden. The manager informed us that the range of fees charged at 8th December 2008 was between £371.00 and £416.00 per week and did not include costs of hairdressing, personal toiletries and private chiropody. The home has produced its statement of purpose and service user guide, which gives detail of its services. Further information can be obtained from the manager. Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is ‘0’ star. This means that the people who use this service experience poor quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. This key unannounced inspection was carried out on 5 and 8 December 2008, starting at 10.30 hours on the first day and finished at 16.45 hours. On the second day, the inspection started at 09.30 hours and finished at 17.30 hours. There were 62 people in residence at the time of this inspection, 30 of whom had dementia. The manager was present on both days of this inspection. The inspection included a tour of the premises, examination of care documents and other records, which included medication, complaints and staff files. We spoke to ten people living at the home, six relatives and nine members of staff. The care of four people who used the service was examined and some aspects of care were observed. We looked at the information contained in the ‘Annual Quality Assurance Assessment’, which was submitted to us before this inspection. We considered the information we received from notifications of incidents and accidents at the home and the way they had been managed. We looked, in particular at two complaints, which people living at the home had informed us about. We also considered the views of people who were using the service and of their relatives. Feedback on our findings was given to the manager during and after our inspection on both days. We also met briefly with Ms Pauline Grainger, a trustee of the company. We would like to thank all the people living at the home and their relatives and staff who helped with this inspection. What the service does well: Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 6 There is a good and committed staff team, which is working hard to provide as good a standard of care as they can. People who use the service praised the care staff, who they described as ‘hard-working and friendly’. The accommodation and facilities, on the whole, is of good standard. People living at the home said that they found it to be spacious and comfortable. What has improved since the last inspection? What they could do better: The home’ s statement of purpose and service user guide needs improvement. They should give more information about the service that is provided for people with dementia and other information as contained in the relevant guidance and regulations. Staff must make sure that full assessments are carried out before people are admitted to the home. These assessments will help to ascertain whether identified needs can be met or not. The manager and her staff must make sure that individual care plans are appropriately developed and implemented. In doing so, they need to involve people who use the service and their relatives as much as possible. Care provided must be properly recorded, evaluated and regularly reviewed. The management and audit of medicines must be improved in order to safeguard the health and wellbeing of people who use the service. It is important for staff, who administer medicines to be appropriately trained and competent to do so. Although staff were described as ‘good and friendly’, there is a need to protect and promote the dignity of people who use the service at all times. This responsibility rests on all staff and managers of the service. Management and staff need to review and improve the provision of social and recreational activities in relation to the needs and capabilities of people who have dementia and who are less able. This will help to avoid the isolation and withdrawal of people who have dementia and improve their quality of life. Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 7 The catering arrangements and the provision of the meals service were of concern to a number of people for a long time. Cooked meals were not served at their optimum temperature because they had to be transported from another site to the home. The registered provider must take urgent action to make sure that the meals service is improved for the benefit of people who live at the home. People must also be given opportunities to make effective choices for their meals and drinks. It is also vital that people who need help with eating are appropriately assisted to do so. Although there was a good complaints procedure in place, the management of complaints must be improved and outcomes of investigations must be appropriately communicated to complainants. The registered provider must improve the physical environment of the home. Adequate and comfortable seating arrangements must be made available at all times. Laundering tasks need to be carried out to a better standard. There is a need to improve the hygiene standard at the home at all times. The registered provider must take action to ensure that there is sufficient care staff working at the home at all times, in order to fully meet the needs of people who use the service, in particular those who experience dementia. Consideration must be given to the dependency needs of people who live at the home, the lay out of the building and to the non-care duties that are expected of the care team. This will help to safeguard the health and wellbeing of people who use the service. There is a need to improve the recruitment and selection procedures used at the home in order to make sure that all pre-employment checks are appropriately sought and obtained before staff start their employment. It is also necessary for arrangements to be made for all relevant documents relating to pre-employment checks to be accessible to CSCI for inspection. The manager must review the training needs of staff and take action to address any shortfalls, some of which are highlighted in this report. The manager must also make sure that a plan for the provision of staff support and supervision is developed and implemented. The registered provider must ensure that appropriate quality monitoring methods and quality assurance system are available and are effectively used in order to improve the service. Staff must make sure that all health and safety procedures are appropriately implemented at the home so as to control and prevent infection. This will promote the health and wellbeing of people who live at the home. Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 8 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. Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 9 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 Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 10 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): 1 and 3. People who use the service experience adequate quality outcomes in this area. We have made this judgement using available evidence, including a visit to the service. Insufficient information was provided about the home and its services and this could affect the choice that people make about their placement. Assessments of needs were not always appropriately carried out before people were admitted to the home and therefore they could not be assured that their needs would be met. EVIDENCE: The home has produced its statement of purpose and service user guide. Although, we did not see copies of these documents on display at the home, staff assured us that people using the service and their representatives were provided with them. The statement of purpose outlined the facilities on offer and also the aims and objectives of the service. However, both documents lacked important information and were therefore not in line with the care home Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 11 regulations. They did not, for example, contain information about arrangements for the delivery of care to people who experience dementia. The statement of purpose had no information about the home’s complaint procedures, except for the front copy of a booklet on complaints. The service user guide had a summary of the complaints procedure but this did not include the timescale for the management of complaints. We noted that the service had also produced a separate booklet ‘A home from home’, which contained the charges that were applicable for the type of care that people required. Both the statement of purpose and service user guide contained information that was no longer correct because of changes that had taken place. During our visit, we met one person who was being admitted and her relatives. The relatives stated that they had obtained information about the home from the CSCI website. They had visited the home three times and spoke to the social worker involved in the placement, but had not seen the full assessment of needs of their loved one. The care files of three people who had recently been admitted to the home were checked. Two of the three people concerned were funding their own placement at the home. There was no assessment of needs for one person before his admission to the home. The assessment of needs for the second person was very basic and did not cover all the relevant areas of care. In both cases, there was no assurance, prior to admission, that the home could meet their needs. There was a care management assessment in place, for the third person, which had been prepared and submitted to the home by the placing social worker, before the person was admitted. This helped to make sure that her needs could be met. The home does not provide an intermediate care service. Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 12 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. People who use the service experience poor quality outcomes in this area. We have made this judgement using available evidence, including a visit to the service. The personal and social care needs of people who use the service were not always appropriately addressed and this led to inadequate care being provided to them. The management of medicines was not satisfactory. These shortfalls could adversely affect the health and welfare of people using the service. EVIDENCE: We spoke to a number of people who lived at the home and to some relatives who visited their loved ones during the inspection. Some of them told us that the care that was provided was fairly good. They said that care staff were ‘hard-working and friendly’. Others stated that they were concerned about staff’s ability to meet care needs of people in a consistent manner. They cited examples where they felt they had missed out on aspects of personal care and attention. Some people commented that they felt there was insufficient care staff at most times and this led to a poor standard of care at the home. Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 13 People using the service and who were able to express their views commented that personal care was provided to them in their own bedrooms or in bathrooms. This helped to maintain their privacy. However, we noted that a number of people, in particular those who experience dementia, were in poor attire for most part of the day. We checked the care that was planned and provided to four people who lived at the home. Two of them were receiving dementia care. We noted that individual care plans were broadly based on the assessments of needs. Risks were identified and assessed. We noted that nutritional screening of individuals was also carried out. However, actions to be taken to meet care needs and identified risks were not always clear or relevant. In one instance, the care plan of one person stated that she had very poor mobility and was unable to move from her chair. However, the action to manage her personal and hygiene care needs was described and recorded by staff as ‘self-caring’. Her relatives told us that they visited regularly in order to give her the much-needed personal care, including bathing. They had also written to the home and complained about the poor standard of personal care that was being provided and was still awaiting an answer from the home management. Although the assessments of people who had dementia, included some of the care needs arising from their conditions, their care plans lacked relevant information on how such needs would be catered for. There was, for example, no individual plan for social stimulation. In another instance, one person was identified by the relevant health care professional as having ‘anaemia’, but his nutritional care had not been reviewed to take this into account. The management of continence for a number of people was in the main left to the use of continence wear, although individual care plans suggested regular toileting. During both days of our visits, we saw a number of armchairs without their top cushions. Staff confirmed that they had been taken to the laundry because they had been wet with urine. The relatives of one person said that they had to leave written instruction in the room of their mother to ensure that staff took notice of the fact that she only liked to drink milk or water. We checked her care plan and saw no record of such dietary preferences. We noted that the existing care plan documentation was poorly used and this led to a lack of relevant information on which to develop and implement a care plan. We found that care records were kept separate from the care plans. Although, care staff said that they knew about the needs of people who they were caring for, there was little evidence that they were referring to individual care plans, in a consistent manner, in order to ensure they were meeting identified needs. Care interventions were recorded in a very generalised manner. We saw numerous entries like ‘ assisted with personal care, good diet taken, self-caring, has been fine’. In the care plans that we checked, there was Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 14 little or no record of any care interventions about social care, mobility and continence. We noted that individual care plans had not they been regularly reviewed. In some cases, parts of the care plan or risk assessments had been reviewed, but these were dated almost three months before this inspection. The review documents were often ticked as completed, but there was no information about how the review was done and what the outcome was. Relatives told us that they had not been invited in any care plan reviews. Although the home had use of a policy and procedures for the management of medicines, these were not always followed. Medicines were stored in each of the four wings of the building. Some of the storage areas were rather small and cluttered with equipment and boxes. The medicines administration records that we checked showed various shortfalls. Medicines received at the home were not appropriately recorded and therefore could not be accounted for. An item of controlled drugs was not appropriately recorded when it was received at the home. In a few instances, records were not signed for medicines, which were either given or omitted. One item of prescribed medicine was not administered on a few occasions because the person concerned was sleeping. No action was taken to find a solution to this matter. Some people were prescribed medicines, which were to be administered when they required them. However, there was no information either in care plans or elsewhere to guide staff in the administration of such medicines. One relative told us that staff would very often leave her mother’s tablets on her bedside table and she would find them still by her side when she visited. Complaints addressed to the home had also included issues about poor medicines administration. At the time of this inspection, none of the people living at the home were administering their own medicines. Although, the registered provider had told us in the ‘Annual Quality Assurance Assessment’ document that was submitted to us, prior to this inspection, that senior staff at the home carried out checks on medicines, there was no evidence of their outcomes. We spoke to a few senior members of staff (team leaders) about the administration of medicines. We noted that it was only the team leader who administered medicines. There was usually one of them on each day shift and they also acted as ‘duty managers’. One team leader told us that she had undertaken a one-day training on medicines ‘a few years ago’ and could not say whether it was accredited. Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 15 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. People who use the service experience poor quality outcomes in this area. We have made this judgement using available evidence, including a visit to the service. There were not sufficient and appropriate social and recreational activities for people who lived at the home, in particular those who have dementia. This led to a lack of social stimulation and could lead to their withdrawal from social life. People who used the service were not always provided with opportunities to exercise choice. The meals service was not satisfactory. These issues could affect people’s quality of life. EVIDENCE: The accommodation was organised in four wings, two on each floor. People who had dementia occupied the wings on the ground floor and others lived on the first floor. During our visits, we noted that people across the four units were spending most of their time sitting in lounges or in their own rooms. We noted that a few people were able to decide and choose how to spend their daytime. We found that some people were happy watching television and reading. One person told us that he kept himself busy by undertaking a variety of art works on his own accord. Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 16 On the second day of our inspection, we noted that three people were engaged in a morning session of ‘Tai Chi’ in the café area on the ground floor. One person said that he was able to go out in the vicinity of the home by using his motorised chair. However, we found that people, who were more dependent on care staff and who were not always able to make their own decisions, had very little social stimulation. We observed that there was little social interaction between staff and people living at the home. Staff told us that they were mostly busy with meeting the physical care needs of people. We noted that there were two members of staff, who were responsible for co-ordinating recreational and social activities for people who lived at the home. In discussion, they said that they were only given 9 hours to do so. They explained that six hours were dedicated to people who had dementia. They had organised some activities like arts and craft, floor games and skittles and a few reminiscence sessions. We checked records of such activities and found out, for example, that the last reminiscence session had taken place in July 2008. A relative told us that she would take her mother out regularly and also for over night stays at her place, otherwise she would spend all her time indoors. In discussion, care staff stated that they would often take residents out when they were off duty, and without pay, as there were ‘so few outings’ for them. Although there was a document to record the personal history of people who lived at the home, this was not always completed and therefore not appropriately used for activities like reminiscence therapy and in building a relevant activities plan. We also noted that social care needs of people were poorly assessed in individual care plans. Such needs were therefore inadequately met. The home had a kitchen on the ground floor, but it was not used to prepare and cook the meals that were served to people who lived at the home. The manager stated that the kitchen would be used for preparing breakfast meals and occasionally for baking cakes. The main meals of the day were cooked at a different care home of the company and transported to Cotleigh by van and in heated trolleys. A number of people who lived at the home had told us that they were not satisfied with the quality of the meals being served at the home. One person said that he was buying food in the local area on a regular basis because the meals were, according to him, of poor quality. We witnessed the arrival of meals at the home. The cook was asked to check the temperature of the some items of food at the point they had been put into containers to be transported and the temperature at which it was received at the home. In most cases, the meals were not at their optimum temperature as they had undergone a loss of between 12 to 14 degrees, before being served at the home. Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 17 We looked at the menus displayed at the home. Staff explained that the menus were developed on a corporate basis and were not sure how the preferences of people living at the home were taken account of. On both days of our visit, people were given a choice of the main meal, which was served with seasonal vegetables and other condiments. There was also a choice of deserts. We observed the serving of lunch in one of the wings used by people who have dementia. The dining area itself was not clean and pleasant. Staff explained that they assisted people in their care by ordering meals that they liked. There were thirteen people in the wing where we were observing lunch. Eleven people had pork steaks and two had fish pie. All were served with orange drinks and there was no attempt to check whether people would like a different drink. There were a number of people who had difficulty in eating their meals. There was only one carer in that dining area, helping one person with eating her meals. No equipment like special cutlery or plate guards was used to assist some people in eating their food. In discussion, staff agreed that the meals had gone cooler by the time they were served at the dining tables. Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 18 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. People who use the service experience poor quality outcomes in this area. We have made this judgement using available evidence, including a visit to the service. The management of complaints was not in line with the home’s own policy and procedures and was unsatisfactory. The service was therefore less able to respond to the views of people who used it. EVIDENCE: There was a complaints procedure in place and it gave information on how to make a complaint, its various stages and who would deal with it. However the procedure was not correctly referred to, in the home’s statement of purpose and service user guide. The home also had a whistle blowing policy to enable staff and members of the public to disclose information of concern to them, if they felt they could not use the existing complaints procedure. We spoke to some relatives and they confirmed that they had received information about the complaints procedure and would use it when required. We had received information from the ‘Annual Quality Assurance Assessment’ that the home had received two complaints and four adult safeguarding referrals in the last twelve months before the 12th July 2008, the date at which they submitted that document to us. We checked the complaints record and noted that complaints were not appropriately acknowledged and recorded. There was no consistent method in which complaints were recorded. We looked at various documents and found Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 19 that four complaints had been received after July 2008 up to our visit. There was, at times, insufficient information about the nature of the complaints, the dates they were received and the form in which they were received. There was also inadequate record of their investigations and their outcomes. We noted that some of the complaints had not been fully dealt with, because of the management changes at the home. The relatives, of two people who used the service, had copied us in their letters of complaints. In both cases, the complainants had addressed their complaints to the home in November 2008. Although staff had sought to respond to the complaints, there was no record relating to their investigations and outcomes. We looked at the issues that the complainants had raised. These matters are included in the sections of ‘Health and Personal Care’ and on the ‘Environment’. On the basis of the findings of our inspection, we found that both complaints were fully justified and should be upheld. We will advise the service to make sure that it adheres to the relevant regulations at all times. There was also an adult safeguarding policy in place to promote the safety and welfare of people living at the home. There had been a number of adult safeguarding referrals made to the local safeguarding team of the Social Services department, since our last inspection. These referrals had been resolved and improvement has been made in the way people who live at the home are protected from harm. In discussion, senior staff indicated that they have received training on adult safeguarding issues and showed a good understanding of how local procedures were implemented. However, there were some care workers who were still awaiting training on adult safeguarding. Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 20 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. People who use the service experience poor quality outcomes in this area. We have made this judgement using available evidence, including a visit to the service. The physical environment was not well maintained and was not kept in a hygienic condition and this could affect the safety and wellbeing of people living at the home. EVIDENCE: Cotleigh is purpose built to provide accommodation for up to 62 people. The accommodation is provided on two floors, which are divided in two units each. This allowed for provision of care and support to smaller groups of people. There are passenger lifts and stairs to facilitate access between the floors. The manager explained that the ground floor was used to accommodate people who had dementia. The first floor was used by other older people who needed personal care. Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 21 We toured the building in the company of the manager. We noted that the main entrance at the front of the building was wheelchair accessible. The external doors were kept secure by the use of an electronic keypad. This prevented people who had dementia to wander out of the building. Each of the units had dining and sitting areas, a kitchenette and a medicines storage area. There was also a larger lounge in the main building, where people could meet for social events. The kitchen and laundry facilities were located on the ground floor. However, we noted that the kitchen was not used for the preparation and cooking of meals, except for some items of breakfast. The manager explained that it was the intention of the company to re-equip the kitchen, together with the necessary resources, so that the main meals for the people living at the home could be cooked on site. During our inspection, we had noted that the lack of a fully operating on- site kitchen was affecting the quality of the meals that were provided to people living at the home. We looked at various communal areas. We found that a number of armchairs had no cushions. In some instances, people were provided with pressure relieving cushions, which had a rubber or plastic cover, to sit on, instead of the cushions. We noticed that there were bins with yellow plastic bags near lounges and in communal toilets. They were used for soiled continence pads and other clinical waste. In some cases, they gave rise to malodours. We checked the dining areas and found that they were not kept in hygienic conditions. There were dried food remnants and stains on the dining tables, trolleys and microwaves. The walls in one kitchenette appeared to be stained and were not clean. Some bins were left without covers. We found that some parts of the communal areas to be dusty and the floor covering to be unclean. There was a designated smokers’ room but it had poor ventilation and its doors were left open. Therefore, the smoke drifted along corridors and other smokefree areas. Medicines storage areas were untidy and cluttered with various boxes, equipment and other non-medical items. We viewed a few bedrooms with the permission of their occupants. A number of people said that they were generally happy with their accommodation. Some people had brought in their own small items of furniture and other personal memorabilia and were able to personalise their bedrooms. Although bedrooms were well decorated, we noted that some parts were dusty and unclean. Boxes of continence products were often kept in en-suite toilets and shower rooms, besides personal toiletries. This could hinder easy access to these facilities. One person told us that the drains in her shower room had not been working for months and that staff could not do anything about it. Another person said that his room was not cleaned on a regular basis. He said that his relatives had complained about the poor hygiene standards at the home and that they were waiting for the matter to be resolved. People said that there were not enough domestics at the home, in particular during evenings and weekends. We checked the duty rota and found that there Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 22 were often fewer domestics on duty during those times and that they finished all their shifts at 15.00 hours. Care staff commented that they had to carry out a number of non-care duties, like ‘mopping floors after every meal’ and ‘deal with laundry tasks’. A number of relatives told us that they were not satisfied with the laundry service. Clothes would often be returned discoloured and misshapen. We checked the laundry facilities. The laundry room was rather small and cluttered with laundry baskets and laundry bags. We noted that there was only one washer. It had a sluice programme and was able to deal with soiled linen. The laundry worker commented that there were not enough washers to deal with the quantity of linen that had to be washed. The surrounding grounds were appropriately maintained for the time of the year. Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 23 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, 29 and 30. People who use the service experience poor quality outcomes in this area. We have made this judgement using available evidence, including a visit to the service. The number and mix of care staff deployed on duty was not always sufficient to meet the complex needs of people using the service, in particular those who experience dementia. There were some shortfalls in staff training and development. These issues could affect the health and welfare of people who use the service. EVIDENCE: The home was registered to provide care for up to 62 older people, 30 of whom had dementia. The accommodation was organised in four ‘wings’ over two floors, in order to allow for smaller group living. At the time of this inspection, there were 30 people in the ‘dementia’ unit and 32 other older people, in residency. People who had dementia were accommodated on the ground floor. Besides the manager, the team leader and other ancillary staff, two care workers were scheduled to work on each wing. However, for a short period of about thirty minutes to one hour, during the day, we found that only one care worker was deployed to work across two ‘wings’. The care worker was looking after 30 people. We highlighted this unsatisfactory staffing level to the manager and action was to redress the situation. We looked at the duty rota and sampled the level of care staff deployment on some dates in November and December 2008. We found that two care workers Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 24 were usually scheduled to work on each wing during day and one on each wing at night. However, on several occasions, in particular, in the afternoons and during weekends, we found that fewer care workers were actually deployed. We noted that there was only one team leader on day shifts. They were responsible for the management of their shift, the administration of medicines and for various aspects of communication with staff, relatives and other visiting care professionals. We noted that about nine dedicated staff hours were available for the organisation and co-ordination of social and recreational activities at the home. We found that the planned care staffing level was affected by absences, including holidays, training and by the arrangements for new staff to work under supervision (buddying), as their vetting had not been completed. Care workers told us that the team leaders were always ‘too busy’ to be able to help them with actual care interventions. We spoke to a number of care workers. They commented that besides providing care to people living at the home, they also had to carry out some non-care duties, which included some laundry tasks, cleaning and tidying, as there was no domestic service in the late afternoon. We were told that, the night care workers, in particular, were expected to undertake more of the laundry duties and to do the ironing. A number of people, including staff and relatives told us that the home was persistently short staffed. This was confirmed during our visit. The staffing level at the home was not based on the dependency of people using the service and the lay out of the building. The care staffing level was therefore insufficient to meet the complex needs of people who experience dementia and who were frail due to old age and ill health. A number of new employees had joined the home since our last inspection. We looked at the procedures that were used in staff recruitment and selection. All new staff had been checked against the ‘Protection of Vulnerable Adults’ (POVA) list before they started to work at the home. However, the home had not received their disclosures from the Criminal Records Bureau before they had started working. The manager explained that in all cases a risk assessment had been carried out and that the staff concerned had worked under supervision until they had received their disclosures. A few members of staff were still awaiting their disclosures. However, given the level of staffing, it was difficult to comment on the effectiveness of the supervision that was provided to staff, who were awaiting their disclosures. The manager showed us information about the disclosure of individual members of staff that she had received from the company. The documents were unsigned and therefore not attributable to the person who countersigned the application. We were not able to access the original disclosure documents for verification. Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 25 We checked the files of three new members of staff. In one instance, only one written reference was obtained before the person started working at the home. Some new members of staff told us that they had received appropriate induction training. We spoke to seven care workers about the training they had received in order to equip them with the required skills and knowledge to provide care, especially to people who experience dementia. Four care workers said that they had received a one-day training on dementia. Three others said that they had not yet received training on a range of topics, including dementia, adult safeguarding, moving and handling. One new member of the care team was working without having received training on moving and handling people. We spoke to a team leader who had the task of administering medicines at the home. She said that she had had some training on medicines administration a few years ago, by a dispensing chemist. None of the care staff we spoke to had yet received training on the ‘Mental Capacity Act’. They therefore, lacked guidance on how to work with people whose capacity to make decisions may be uncertain or questionable. We also noted that no training had been provided to staff on issues of equality and diversity. The manager explained that there was an on-going staff-training programme and care staff would be included in it. We noted that 17 out of 33 care staff who worked at the home had achieved their ‘National Vocational Qualifications (NVQ) level 2 in care and eleven others were following this course. Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 26 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, 36 and 38. People who use the service experience adequate quality outcomes in this area. We have made this judgement using available evidence, including a visit to the service. Management arrangements at the home were not robust enough and this had led to a lack of accountability and some poor practice. Quality monitoring and quality assurance methods were not adequately used to evaluate and improve the service for the benefit of people who use it. EVIDENCE: A new manager was in post. She had been transferred from another home of the company. She is a first level registered nurse and has experience of working in and managing residential care. She had completed her ‘Registered Managers’ Award. She stated that she was applying for registration with our commission (CSCI). Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 27 We noted that there had been various management changes at the home, in the last twelve months. The company had used its other registered managers to work at the home on a temporary basis, without seeking and completing their registration. People who used the service, relatives and staff told us that these constant management changes had affected the standard of care provision and had been unsettling for all. We had previously highlighted these issues, in particular the management of events at the home, (notifications) in our ‘Annual Service Review’ (October 2008). The manager explained that action has been taken to improve how such events are handled and reported. We looked at the management arrangements that were in place at the home. We found that besides the manager, there was a team leader on each day shift. The latter was responsible for the management of the shift and the work carried out by the care workers on that shift. There were other management support staff, which included clerical officers. Furthermore, management at the home had use of corporate services like ‘human resources, quality assurance, training and finance’. We looked quality assurance methods that were used by home in order to improve its services. The manager stated that as she was new to the home, she would be considering using the existing quality monitoring tools, like the managers care evidence check list, which included audits of care plans and medicines. We looked at the three reports of the provider’s monthly visits to the home. These were undertaken by a quality assurance manager of the company. Each report contained an action plan. One of them had highlighted inadequacies in care records but there was no evidence that action had been taken to rectify these issues. We spoke to a number of staff and they told us that they had not received regular supervision because there had been so many management changes at the home. Some of them felt that they were not adequately supported in the work they do. They were, particularly concerned by the number of staff, who had left the home and the ability of getting new staff. The previous manager had conducted a ‘service user and stakeholder’ satisfaction survey in April 2008. Fifty responses were received. Twenty-seven of them contained positive comments about the service and twenty-three passed negative comments. These were mostly about the provision of meals and the quality of the laundry. A few responses were about the insufficient number of care staff being deployed on duty. We have highlighted similar concerns as a result of our inspection. The manager explained that arrangements were in place to support people living at the home with the management of their personal monies. All financial transactions were appropriately witnessed and recorded. Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 28 Information regarding the maintenance of equipment and utilities in use at the home was provided in the home’ s ‘Annual Quality Assurance Assessment’. We noted that all equipment to assist with moving and handling people had been appropriately serviced. The passenger lifts were maintained according to the relevant regulations. However, we found that the handling of refuse at the home to be of concern and not in line with the prevention of infection. This could affect the health and safety of people who live at the home. Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 29 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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Not applicable. 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 OP3 Regulation 14 Requirement Full assessment of care needs must be carried out for each person before they are admitted to the home, to make sure that their needs can be appropriately met. Individual care plans must be improved to ensure they are appropriately developed and implemented. The care provided must be properly recorded, evaluated and reviewed. Risks that people face must be appropriately assessed and managed. These actions will ensure that the needs of people using the service are properly addressed. All medicines received at the home must be appropriately recorded so they can be accounted for. Prescribed medicines must be appropriately administered. Staff must sign for any medicine that they administer and also indicate reason for any omission. Staff who administer medicines must be appropriately trained to do so. These actions will help DS0000069439.V373523.R01.S.doc Timescale for action 09/03/09 2. OP7 15 16/03/09 3. OP9 13 09/03/09 Cotleigh Care Home Version 5.2 Page 31 4. OP10 12 5. OP12 16 6. OP15 16 7. OP16 22 protect the health of people living at the home. The dignity of people using the service must be protected and promoted at all times, in order to uphold their rights. The social care needs of people who use the service, in particular, those who have dementia, must be properly assessed and action taken to meet such needs must be part of the individual’s care plan. Social and recreational activities that are organised must reflect the preferences and capabilities of people using the service. This is to ensure that they are provided with appropriate social stimulation and to enhance their quality of life. The registered provider must take urgent action to ensure that people living at the home receive ‘varied, appealing and wholesome’ meals. Cooked meals must be provided at their optimum temperature. People must also be given opportunities to make effective choices for their meals and drinks, at all times. Staff must make sure that people who need help with eating are appropriately assisted to do so. These actions are necessary to ensure that the dietary needs and preferences of people using the service are met. The management of complaints must be improved to include all the relevant information about their receipts, investigations and outcomes. In general, complaints must be addressed and concluded within the stated timescales. These actions will help to make the service more DS0000069439.V373523.R01.S.doc 09/03/09 16/03/09 30/03/09 09/03/09 Cotleigh Care Home Version 5.2 Page 32 8. OP19 23 9. OP19 23 10. OP19 23 11. OP26 16 12. OP26 16 13. OP27 18 responsive to the views of people who use it. Staff must make sure that appropriate and comfortable seating arrangements are in place, for people living at the home, at all times. The operation of the ‘smokers’ lounge must be improved to make sure that tobacco smoke does not drift to adjoining smoke-free areas of the home, as required by the relevant regulations and for the benefit of people who live and work at the home. Action must be taken to make sure that drains in all en-suite shower rooms are in good working order, so that people can effectively use them. All parts of the home must be kept clean, hygienic and free from malodours at all times. This will help to make the place safe and pleasant. The laundry service must be improved to make sure that the clothes of people who live at the home are not damaged in any way. The care staffing level must be improved to fully meet the needs of people living at the home and in order to safeguard and promote their health and wellbeing. The care staffing level must be based on the dependency needs of people who use the service, the lay out of the building and the non-care duties expected of care staff. The registered provider must also ensure that there is an adequate number of domestic and laundry staff on duty at all times, in order to maintain the appropriate level of hygiene at DS0000069439.V373523.R01.S.doc 09/03/09 30/03/09 16/03/09 09/03/09 09/03/09 09/03/09 Cotleigh Care Home Version 5.2 Page 33 14. OP29 19 15. OP30 18 16. OP33 24 17. OP36 18 18. OP38 13 the home. Two written references must be sought and obtained before staff start to work at the home. Arrangements must also be made for original disclosures of staff to be available for checking, as necessary at a CSCI inspection. These actions will help in protecting vulnerable people who live at the home. All staff who work with people who have dementia must be appropriately trained to do so. The registered provider must review the training needs of all care staff and plan any required training within an agreed timescale. This training must include adult safeguarding, health and safety topics, accredited medicine administration and mental capacity. This action is necessary to safeguard and promote the health and wellbeing of people using the service. Effective internal audits and quality monitoring tools must be developed and consistently used in order to improve the service. Regular supervision must be provided to all grades of care staff working at the home. This will help to improve the standard of care being provided. Staff must take action to improve the handling and management of refuse at the home, in line with procedures to control and prevent infection. 09/03/09 30/03/09 30/03/09 30/03/09 09/03/09 Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 34 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. Refer to Standard OP1 Good Practice Recommendations The statement of purpose and service user guide should be amended and improved to include all the necessary information. A protocol on the administration of ‘when required’ medicines should be developed and implemented to ensure consistency of such practice. The complaints procedures which are included in the home’s statement of purpose and its service user guide should be reviewed to make sure they contained all the relevant information and are the same as the original procedures. The storage facilities, in particular, for medicines, should be improved to avoid ‘clutter’. The registered provider should improve the way the reports of the monthly visits to the home, are used and monitored in order to improve the standard of the service. 2. OP9 3. OP16 4. 5. OP19 OP33 Cotleigh Care Home DS0000069439.V373523.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. 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