CARE HOMES FOR OLDER PEOPLE
Coton Hill House Berwick Road Shrewsbury Shropshire SY1 2PG Lead Inspector
Patricia Scott Unannounced 3rd June 2005 09:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Coton Hill House E56 S20665 Coton Hill House V 230962 UI 060605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Coton Hill House Address Berwick Road Shrewsbury Shropshire SY1 2PG 01743 235788 01743 240002 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Coverage Care Shropshire Limited Mrs Lilian Mary Langdown Care Home 45 Category(ies) of 30 x Old age, not falling within any other registration, with number category (OP) of places 15 x Dementia (DE) Coton Hill House E56 S20665 Coton Hill House V 230962 UI 060605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home may accommodate a maximum of 45 service users. 2. The home may accommodate a maximum of 15 persons with dementia requiring personal care. 3. The remainder being persons who are over 65 years of age who do not fall within any other category. Date of last inspection 23rd February 2005 Brief Description of the Service: Coton Hill House provides care for 30 elderly service users and 15 service users with dementia in single bedrooms with communal sitting, recreational and dining space in five separate units. The care home has large, well-maintained gardens that provide safe and accessible areas for all service users. The home is situated close to Shrewsbury town centre with views across the River Severn. The local transport system has regular bus services for those who do not have their own transport. The home provides visitors with car parking facilities. Coton Hill House E56 S20665 Coton Hill House V 230962 UI 060605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on the 3rd June 2005 between the hours of 09.00 and 11.00 and was unannounced. The National Minimum Standards for Care Homes for Older People focus on achievable outcomes for service users – that is the impact on the individual of the facilities and services of the home. Evidence was looked for that the standards were being met and a good quality of life enjoyed by service users through: • Discussions with service users, families and friends, staff and managers. • Observation of daily life in the home • Scrutiny of written records (including care plans for 4 service users). The statement of purpose was used to assess how far the home’s claims to be able to meet service user requirements and expectations were being fulfilled. What the service does well:
The home provides for the needs of elderly people including those with dementia through small group living and a wide variety of activities. Service users were seen to be treated in a respectful and dignified way and some of those spoken with stated that they were certainly very happy to be living at Coton Hill. After appropriate risk assessment, service users are not discouraged or unduly restrained from undertaking activities solely for fear that for example, they may hurt themselves. The building is used for a number of purposes as it also incorporates day care facilities. The way in which this is managed protects the privacy of service users whilst allowing the building to be used in other ways. The home is not purpose built and service users on the ground floor dementia units are unable to access other parts of the home. Inevitably, service users come to a ‘dead end’ when walking around their unit. The experience and training of staff with dementia needs is such that this aspect is well managed. Coverage Care provides training to a level that creates a trained and experienced staff team that is well managed as examination of files and in discussion with staff and the manager showed. Staff were happy with the training they do with ambitions to further their career in care.
Coton Hill House E56 S20665 Coton Hill House V 230962 UI 060605 Stage 4.doc Version 1.30 Page 6 The home’s values and philosophy as stated in the statement of purpose, centre on promoting service users’ independence through enabling them to make their own decisions, encouraging their individuality, keeping up with family and community contacts and finding out if they are satisfied with the quality of life and care in the home. Mrs langdown’s style of management enables service users to make decisions for themselves, choose how and where they spend their time and enable them to adjust to living in the ‘home’ environment. She was seen about the home during the inspection and talked openly with service users that wished to ask something of her. Her commitment to furthering her knowledge in dementia care has an impact on the way care is delivered and the National Minimum Standards that are achieved or exceeded. In addition to this she demonstrated her enthusiasm to enable recruitment of people with disabilities to work in the home. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection.
Coton Hill House E56 S20665 Coton Hill House V 230962 UI 060605 Stage 4.doc Version 1.30 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Coton Hill House E56 S20665 Coton Hill House V 230962 UI 060605 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Coton Hill House E56 S20665 Coton Hill House V 230962 UI 060605 Stage 4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 3 The homes statement of purpose and service user guide is good providing service users and prospective users with details of the services the home provides, enabling an informed decision about admission to the home. EVIDENCE: The information provided to service users gives details of needs assessment to be conducted prior to admission and examination of care plans on the units confirmed that this process had been carried out. A service user spoken with stated that their relative had been able to see information about the home prior to their admission. The statement of purpose and service users guide were on display in the foyer. Coton Hill House E56 S20665 Coton Hill House V 230962 UI 060605 Stage 4.doc Version 1.30 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 10 There is a clear, consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet service users needs. Personal support in this home is offered in such a way as to promote and protect service users’ dignity and privacy in their daily life. EVIDENCE: Care plans looked at for 4 service users were consistently completed and had all the useful information in them that is necessary to enable a care worker to provide the right care for that individual in a way that meets their wishes and preferences. Ascertaining such information can be difficult when an individual has dementia or mental health problems and records provide evidence of consultation with families and other supporters. The information that was read showed that individuals receive the level of care which their own situation requires. All care plans seen had been signed by the service user. Visits by other health care professionals are documented e.g. GP, CPN (Community Psychiatric Nurse). Regular monitoring and review of a service user’s condition takes place to ensure that the correct treatment and care is being given.
Coton Hill House E56 S20665 Coton Hill House V 230962 UI 060605 Stage 4.doc Version 1.30 Page 11 Staff were heard talking with service users in a respectful manner and of noting their movement about the home in a discreet way. At 09.30 am some service users were up and dressed and others were still in their nightwear; each as they wished. Coton Hill has scored a 4 for standard 10, the evidence for which is reflected throughout other standards in this report. Coton Hill House E56 S20665 Coton Hill House V 230962 UI 060605 Stage 4.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed at this inspection. EVIDENCE: Coton Hill House E56 S20665 Coton Hill House V 230962 UI 060605 Stage 4.doc Version 1.30 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed at this inspection EVIDENCE: Coton Hill House E56 S20665 Coton Hill House V 230962 UI 060605 Stage 4.doc Version 1.30 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 The standard of the environment within this home is very good providing service users with an attractive and homely place to live. EVIDENCE: A general tour of the bedrooms and communal spaces demonstrated that the home is purposely designed into small group units each with its own lounge/kitchenette and dining area. These were all in a good state of repair and comfortably furnished. It is easy for service users, elderly frail or those with dementia to find their way around their unit. Service users may join the day centre at any time. Due to the layout of the home there are some ‘dead ends’ particularly on the ground floor dementia units. The manager is taking steps to minimise this aspect of ‘confinement’ by making the garden area more accessible, safe and suitable for people with dementia. This will enable service users to enjoy the garden with minimal supervision. Coton Hill House E56 S20665 Coton Hill House V 230962 UI 060605 Stage 4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28,30 The arrangements for the induction and training of staff are good with the staff demonstrating a clear understanding of their roles. There is a good match of well-qualified staff offering consistency of care within the home. EVIDENCE: Relevant training has been provided and staff spoken with confirmed this. Staff are offered financial support, subject to approval, for individual professional development. Staff observed carrying out their duties were seen to be responsive and understanding of individuals wishes and needs. The staffing establishment and rota are arranged so that there are enough senior staff and are deployed to give the cover required to meet the home’s stated aims. The manager has been pro-active in working with ‘ENABLE’ to recruit people with disabilities to work in the home for which they have been awarded a certificate of recognition. The percentage of staff who have attained NVQ status has reached 64 . Coton Hill House E56 S20665 Coton Hill House V 230962 UI 060605 Stage 4.doc Version 1.30 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,38 The manager has a clear development plan and vision for the home that will enhance the facilities even further. EVIDENCE: All standards assessed have achieved a 4. Safety checks are carried out as seen in fire records. A member of staff was seen checking the fridge temperatures in the kitchenettes. Bedrooms have been assessed and furniture moved around to ensure the safety of service users from falls. One service user was spoken to who had recently had a fall from bed and now felt more confident following the staff’s attention to her problem. Risk assessments were seen on files re falls and behaviour management of people with dementia. The manager possesses all the relevant qualification required within the standards. She has completed a dementia mapping course and a positive
Coton Hill House E56 S20665 Coton Hill House V 230962 UI 060605 Stage 4.doc Version 1.30 Page 17 dementia course, information from which she intends to disseminate to staff within the next 6 months. Discussions demonstrated that she has identified problems with administering the medication system in the home and has instigated changes to practice to minimise errors. During this inspection the results of a recent customer satisfaction survey conducted by Coverage Care and the recent Regulation 26 report for the home of 20th May 2005 were taken into account in assessing standard 33. A service user commented during the inspection that they looked positively to the days ahead and had no complaints but would know who to talk to if they needed to. The manager was seen around the home talking to service users and was receptive to opinions that they had. Coton Hill House E56 S20665 Coton Hill House V 230962 UI 060605 Stage 4.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 N/A 3 N/A N/A N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 N/A 10 4 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 N/A 13 N/A 14 N/A 15 N/A
COMPLAINTS AND PROTECTION 3 N/A N/A N/A N/A N/A N/A N/A STAFFING Standard No Score 27 N/A 28 4 29 N/A 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score N/A N/A N/A 4 4 4 N/A N/A N/A N/A 4 Coton Hill House E56 S20665 Coton Hill House V 230962 UI 060605 Stage 4.doc Version 1.30 Page 19 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement None were made at this inspection Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Coton Hill House E56 S20665 Coton Hill House V 230962 UI 060605 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection 1st Floor, Chapter House South Abbey Lawn SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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