Inspection on 18/10/07 for Coton House

This inspection was carried out on 18th October 2007.

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 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

Coton House 13/01/09

Coton House 04/11/08

Coton House 09/07/08

Coton House 22/06/06

Coton House 26/09/05

Coton House 12/10/04

Coton House 08/06/04

Coton House 08/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Coton House Coton House 55 Coton Road Penn Wolverhampton West Midlands WV4 5AT Lead Inspector Deborah Sharman Unannounced Inspection 18th October 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Coton House DS0000020885.V349496.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. Coton House DS0000020885.V349496.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Coton House Address Coton House 55 Coton Road Penn Wolverhampton West Midlands WV4 5AT 01902 339391 F/P 01902 339391 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) Coton Care Limited Mrs Kalwant Chahal Care Home 27 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (15) of places Coton House DS0000020885.V349496.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home should only accommodate service users with mild dementia. Date of last inspection 22nd June 2006 Brief Description of the Service: Coton House is situated in a very quiet area of Penn, some 400 yards from Goldthorn Hill. The property was built in the 1930s and has been a residential home for the elderly for many years. Coton House is registered for 27 service users aged over 65 years and can admit up to 12 residents with mild dementia. In 2001 the Home had major development and refurbishment with a new purpose built wing of 10 en-suite bedrooms being added. The home is well maintained and as a result of a low turn over of staff has an experienced staff team. Weekly fees range from £349.00 to £399.00 per week. Coton House DS0000020885.V349496.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One Inspector carried out this unannounced key inspection between 9.00 am and 6.00 pm. As the inspection visit was unannounced this means that no one associated with the home received prior notification and were therefore unable to prepare. As it was a key inspection the plan was to assess all National Minimum Standards defined by the Commission for Social Care Inspection (CSCI) as ‘key’. These are the National Standards, which significantly affect the experiences of care for people living at the home. Progress the home has made towards meeting a previous CSCI requirement and recommendation issued to ensure improvement at the last key (June 2006) and random (November 2006) inspections were also assessed. Information about the performance of the home was sought and collated in a number of ways. Prior to inspection the Commission for Social Care Inspection was provided with written information and data about the home in the home’s annual return. Additionally just prior to inspection CSCI sent surveys to staff to seek their views about their experience of working at the care home. These were analysed after the inspection but prior to writing this report. The history of the homes performance was researched too prior to inspection. All this information was analysed prior to inspection and helped to formulate a plan for the inspection and has since helped in determining a judgement about the quality of care the home provides. During the course of the inspection the Inspector used a variety of methods to make a judgement about how service users are cared for. The Registered Manager was available throughout the inspection day to answer questions and generally support the process, as were the proprietors. The Inspector interviewed two senior care staff member, had the opportunity to talk to two new residents, spoke to another resident and her daughter privately and had the opportunity to speak in detail to a further two relatives who were visiting on the day of the inspection. Since inspection the Inspector has also spoken to the Environmental Health Department in Wolverhampton to seek an update on their investigations into a fatal accident, which happened at the home in November 2006 since the last key inspection. The Inspector assessed in detail the care provided to two new residents and aspects of care for two others using care documentation. The Inspector also sampled a variety of other documentation related to the management of the care home such as training, staff supervision, maintenance of the premises, accidents and satisfaction questionnaires recently completed by residents. Coton House DS0000020885.V349496.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Exits have been alarmed to better protect residents with dementia who may wander from the home. Also the main handover period at 7.30am when the whole staff team changes has been staggered to ensure that staff are still available to supervise residents during this period. The manager feels that this is sufficient as there is not such a significant change in staff at other handover periods within the day. Since the last inspection the Fire Service has carried out a fire safety inspection and identified a number of contraventions. The proprietor and Manager assured the Inspector that all the identified areas for improvement have been met and they are awaiting an imminent re inspection. Coton House DS0000020885.V349496.R01.S.doc Version 5.2 Page 7 What they could do better: Several areas for improvement have been identified at this inspection. Care plans need to better reflect assessed need to ensure that sufficient care guidance is available to staff. This was identified particularly in relation to moving and handling residents, medication, pressure area management and special dietary requirements and preferences. Care plans are currently not person centred and at times this is reflected in practice, which is not always individualised and compromises the residents needs, choices and dignity. One resident who is not mobile and dependent on staff for all transfers for example told the Inspector that she is not informed of activities and often has to wait for staff to help her use the toilet. Managers challenged this view but staff meeting minutes confirmed that staff are not always working with all residents equally. The Inspector also observed one care staff member combing six peoples hair one after the other in the lounge using the same comb. This is outdated and institutional poor practice that fails to value people’s dignity, individuality and compromises infection control. Risk in relation to pressure sores and the use of bed rails must be better assessed. Safety systems in relation to the use of bedrails must also improve. Bed rails are currently in use to prevent one service user falling from bed. This had been discussed and agreed with a relative but planned risk assessments have not been carried out. Observation of the bed rails showed them to fit inadequately with the real risk of limb entrapment. A schedule of checks to ensure their safety is not in place and staff would benefit from training to ensure they know how to check bed rail safety during use. Changes in service users health are noticed and acted upon and routine health screening is also provided. Medication is generally well managed but stock control needs to be reviewed. This inspection found that very frequently used prescribed painkillers for one resident had run out. Although a delivery was due the following day, the outcome for the resident potentially is poor as there was no medication available to help her to manage pain should she have needed it. Recruitment is not adequately protecting service users. The files of two new staff were assessed. It was found that the very minimum pre employment checks are not being carried out in a timely way and this has the potential to put residents at risk. It is positive that the home is seeking service users views about the service they provide. This along with complaints and regulation 26 visits by the provider contributes to how the home is quality assuring its own performance. Currently however the home does not have a tool to help it to holistically review and act upon its own performance. Managers said following discussion that they are keen to instigate and develop such a tool. Coton House DS0000020885.V349496.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. Coton House DS0000020885.V349496.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 Coton House DS0000020885.V349496.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, 2, 3, 4, 5 Quality in this outcome area is good. Service users are assured that their needs are assessed before they are admitted to the home. This ensures that the home is confident it can meet peoples’ needs before they move in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s Statement of Purpose and Service User Guide are brochures that inform potential residents and their relatives about the service the home provides. Both these documents require review. The Statement of Purpose was reviewed 12 months ago but should state its intention to accept people with mild dementia only. The Service User Guide was last reviewed in 2004 and therefore does not include information detailed in new regulations introduced since this date. Coton House DS0000020885.V349496.R01.S.doc Version 5.2 Page 11 The Manager assesses people who are referred to Coton House before they are admitted. She also ensures that she has access to assessments carried out by other professionals such as social workers before new residents move in. This provides her with a range of information about the person before she offers them a place. Residents and their relatives are offered the opportunity to visit the home for a meal before deciding whether to move in. The two new residents whose care was looked at in detail had signed contracts on the day they were admitted. This helps them and their relatives to know of the rights and responsibilities of all parties in a timely manner. Coton House DS0000020885.V349496.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, 10. Quality in this outcome area is adequate. Changes in service users health are responded to but systems to support this must improve to avoid the potential for oversight and error. Some aspects of medication management must improve to ensure that health and pain are managed effectively at all times for all service users. There must be better attention to individual needs and dignity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans are available for each resident. They are however brief, some crucial information is sparse and they do not fully reflect the residents’ needs as assessed prior to admission. For example, one residents care plan states ‘no problems’ for communication whereas his assessment shows him to be hard of hearing. His diet care plan states ‘enjoys all food’ where his assessed needs show that he does not like pasta, likes roasts and fish and prefers a soft Coton House DS0000020885.V349496.R01.S.doc Version 5.2 Page 13 diet. Information on the care plan in respect of medication solely states ’ to be administered by trained staff only’. This does not tell the trained staff anything about this service users medication or how he likes to take it leaving the potential for error. The medication care plan for a second resident was the same and the diet care plan for this second resident who is diabetic referred only to a ‘special diet’ without defining this for the benefit of staff to ensure her needs were known and could be met. Discussion with this resident showed that she had to keep reminding staff about what food she couldn’t eat. She stated that she had always controlled her diabetes well and wishes to continue to do so. Moving and handling assessments are carried out but where intervention is required, again there is insufficient written guidance to inform staff how to do this safely and in accordance with resident’s preferences. Where a service user has developed a pressure sore, risk assessments are in place, have been regularly reviewed and the service user is receiving regular treatment from the District Nurse. The home needs to develop its systems to ensure a pro-active approach to reducing the risk of pressure sores developing. One resident for example had been assessed as ‘at risk’ but no action had been taken. The Manager undertook to raise this with the District Nurse service. Otherwise service users general health needs are monitored, health screening is facilitated and medical advice is sought when a change in health is noticed. A relative commented how his Mother had had a chest infection but had improved following a Doctor visit requested by the staff. It was positive to see residents who need to, steadily putting on weight since admission to the home. Baths provided are recorded for monitoring purposes and relatives spoken to were pleased that by providing encouragement staff managed to help reluctant residents to bathe. The hairdresser visits weekly to help residents to maintain their appearance. Communal hair combing by care staff however, as observed by the Inspector must cease to promote residents’ privacy and dignity. One resident who needs significant support with mobility reported having to wait for staff to help her to use the toilet. Staff meeting minutes confirm that managers are aware that staff are not treating some residents equally and it is positive that this is noticed and raised. The development of person centred care plans supported by person centred training for staff will set the expected standard of care for each individual resident and will help to promote this. Medication was assessed for two residents and was fully satisfactory in respect of the one resident. Areas for improvement were identified from assessment of medication records for a second resident. Where medication prescribing directions say ‘take one or two tablets as required’ staff should indicate on the administration records how many have been administered on each occasion. The absence of this does not protect the resident from the risk of under or overdosing and furthermore medication stocks cannot be audited. The Coton House DS0000020885.V349496.R01.S.doc Version 5.2 Page 14 manager for example could not account for why this persons painkiller tablets had run out. This had the potential for a negative outcome for the service user in the event of pain that could be medicated until stocks were delivered. The medication ordering system should be reviewed to ensure that this does not happen again Medication stocks however are held securely and a controlled drug is held safely and is accounted for well in records. Coton House DS0000020885.V349496.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, 15. Quality in this outcome area is good generally. Most residents are satisfied with the activities available. Activities are traditional and are provided on a resource rather than needs lead basis. Service users would benefit if activity provision was individualised and person centred. Service users enjoy their meals but again better attention to individual needs is required. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Entertainers are provided by the home. Staff feel that it is sometimes difficult to motivate residents to join in unless it is something they are interested in. Visiting relatives confirmed that motivation was sometimes low. One resident who spends a lot of time in her room said she is not often informed of the activities taking place. She feels that this is directly related to her lack of easy mobility and it being too much trouble for the staff. She does not feel afforded choice or control. 100 of the thirteen surveys completed by residents (representing half of the resident group) returned to the home indicate complete satisfaction with activities offered. But this is an opportunity for Coton House DS0000020885.V349496.R01.S.doc Version 5.2 Page 16 managers to review how fully the activities offered reflect the needs, abilities and aspirations of residents and systems in place for notifying all residents in advance of activities planned. Relatives said they feel very welcomed when they visit the home and that staff communicate with them well. Meal times are a pleasant experience and where residents require support this is provided in a sensitive manner. Service users enjoy their meals, are consulted frequently about them and are offered alternatives when necessary. Residents can eat in their room if they wish to and are offered this opportunity if they are not feeling well. Records show residents to have steadily gained in weight since admission but better information needs to be available in respect of special diets so these needs can be met at all times. Coton House DS0000020885.V349496.R01.S.doc Version 5.2 Page 17 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, 18. Quality in this outcome area is adequate. Since the last key inspection a service user has died following an accident at the home attributed to an environmental failure. Measures are in place to prevent a reoccurrence. Financial accounting is robust to protect service users financial interests. Not all staff have received appropriate training and recruitment practice is not maximising service users safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In November 2006 a resident died as a result of falling through a window on the first floor. The window restrictor in place had failed in spite of a schedule of checks. Remedial action was taken immediately. Monthly checks continue, a piece of furniture obstructs access to the window as an additional measure now and the Managers cooperated with subsequent investigations conducted by the Police, CSCI, Social Services, Environmental Health and the Coroners Inquest which cited the faulty window as the cause of death. At this inspection the Inspector checked all windows overlooking a high drop and found them to be secure. Following a CSCI recommendation immediately following this incident, handover arrangements have been reviewed to ensure that staff supervision is always adequate. The enforcing authority for Health and Safety has completed its investigation but a final decision has not yet Coton House DS0000020885.V349496.R01.S.doc Version 5.2 Page 18 been made. The Inspector spoke to two relatives and two senior staff who all confirmed that they believe residents to be safe. The home is half way through providing abuse training to its staff group. Half the team received training in 2005 and refresher training is due, the others have not received this training. Senior staff spoken to had received the training and were aware of what abuse is and their role in reporting it should a concern become known to them. Financial records are robust and account for service users income and expenditure. Storage could not be assessed fully as the Proprietor indicated that for security reasons not all the cash is held on the registered premises. She and the manager confirmed however that sufficient monies are always available to service users on the premises. Relatives are happy with how monies are managed on residents’ behalf. The way that new staff are recruited is not sufficiently protecting service users and this which is discussed more fully under ‘Staffing’ needs to be prioritised for improvement. No complaints have been made to the home. Complaints information was not publicly available, as it had fallen down from the wall of the reception area. The manager located the document and returned it to its position to ensure that everybody who visits the home has access to information that tells them how they can complain should the need arise. Coton House DS0000020885.V349496.R01.S.doc Version 5.2 Page 19 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, 26. Quality in this outcome area is good. The environment is homely and comfortable. Residents like their bedrooms, which are personalised with their own possessions. Systems are in place to minimise the risk of most accidents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the environment showed it to be clean, homely and well maintained. The home has additional features for residents’ pleasure such as a fish tank, fountain, separate visitors room and sun lounge. Residents reported liking their bedrooms, which have clearly been personalised. A married couple have two rooms available to them and appreciate being able to use one as a private sitting and dining room. Most bedrooms have en suite toilet and basins with two having full shower en suite facilities. Communal bathrooms and toilets are Coton House DS0000020885.V349496.R01.S.doc Version 5.2 Page 20 finished to a high standard but maintain a homely and domestic style and therefore are not impersonal or overly clinical. Two hoists, a hydraulic bath chair, showers and a passenger lift are all available to support residents with limited mobility. The laundry is well resourced and suitably equipped to promote good infection control. There had been a water leak and on arrival the Inspector found the ceiling in the communal area near the hair salon had fallen in and was receiving attention. Water temperatures are monitored and are within the safe range. All radiators are covered to protect residents from the risk of burns and scalds. Windows are restricted and each room is checked for safety compliance on a monthly basis. The safety of bedrails however has been overlooked in risk assessment and safety schedules and there are no systems in place to assure the safety of the resident using them. Inspection showed that they are ill fitting with the real risk of limb entrapment. The fire officer at his most recent inspection had a number of concerns about fire safety compliance and wrote to the home listing the areas of none compliance. The Proprietor and Manager assured the Inspector that all matters had been dealt with and they are expecting a fire safety re inspection after 14 October 2007. The enforcing authority for health and safety has not yet made a final decision in respect of the accident leading to a service users death as a result of the failure of a window restrictor. CCTV cameras are in use but are not restricted to entrance areas. They are also fitted within the homes corridors for security purposes. Coton House DS0000020885.V349496.R01.S.doc Version 5.2 Page 21 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, 30. Quality in this outcome area is adequate. Staff are supplied in sufficient numbers to meet care needs, and handover at 7.30am has been staggered to afford better supervision of service users at this time. A training system is in place and there is general satisfaction about staff performance amongst most if not all service users spoken to. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of inspection in the morning there were eight staff on duty including five care staff. Four carers are on duty at other times of the day with two waking staff at night. Coton House is fully staffed with no vacancies with a history of low staff turn over. One relative said that she appreciated this as the continuity of staffing is good. The handover system has been reviewed to ensure that there is a staff presence at all times to supervise residents. A fire officer stated that night time staffing levels needs to be sufficient to effectively carry out the emergency plan and he will review this shortly. The Manager is satisfied with the staffing levels and two relatives and two senior staff who were asked, all said they believe the home to be well staffed. Coton House DS0000020885.V349496.R01.S.doc Version 5.2 Page 22 A training programme is in place and records show staff to have undertaken a range of appropriate training courses. Senior staff said that there are always training opportunities and that they feel that the training provided has supported them to be confident and competent in their job role. Records were seen which evidence that disciplinary action was taken when care practice was deemed to be insensitive and fell short of that expected. Two relatives spoke highly of the staff approach describing them as friendly, competent and very good. A resident said some staff are marvellous and sometimes the home was alright. The resident added that other staff make her wait for the toilet for twenty minutes and can be ‘blunt and sharp and there is no need for it’. These examples along with other examples of care practice included within this report demonstrate how staff and residents would benefit from staff receiving training in person centred care. Sufficient checks on new staff are not undertaken to maximise residents’ protection. One staff member has been re employed and had started work without recourse to completing a new application, without completing an updated self declaration re any previous offences, with one verbal rather than two written references, without a Criminal Record Bureau check and without the minimum requirement of having carried out a POVA first check. POVA first checks ensure that the applicant is not listed on the national list of people considered either permanently or temporarily unsuitable to work with vulnerable adults. These were secured a week and two weeks after the staff member commenced potentially putting residents at risk for this period of time. A second new staff member not directly involved in care but with access to vulnerable people and information about them started in employment four months before either the Criminal Record Bureau check or POVA first check were obtained. This is clearly unsatisfactory. The home does not have a high turn over of staff but systems must be urgently reviewed to ensure that such lapses do not reoccur. An induction training system is in place to ensure that new staff are inducted to national standards. Coton House DS0000020885.V349496.R01.S.doc Version 5.2 Page 23 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, 38. Quality in this outcome area is adequate. The management of the home has many strengths but there are shortfalls, which require attention to better promote service users interests and safety before it can be considered to be good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff praised the management of the home stating they appreciate the hands on approach of the manager who is aware of residents needs and is approachable. The response from relatives and service users was more mixed. But the majority of people spoken to were very satisfied with the way the Coton House DS0000020885.V349496.R01.S.doc Version 5.2 Page 24 home is managed. Two out of three relatives described the home as ‘excellent’. The Manager is registered with the Commission for Social Care Inspection. She completed part of the recognised Managers qualification in 2005 but needs to enrol to undertake the second part. The Managers training records show that she has undertaken a range of training courses over the years to provide her with necessary knowledge and skills. However she has undertaken little training since 2005 and accepted the need to review her training needs and develop an action plan to meet any needs identified. Similarly although she joins managers meetings, these were infrequently evidenced. To compound this, discussion and perusal of records demonstrate that the Manager is not receiving supervision with sufficient regularity. Records show she has received one supervision in 2007 (March), which was confirmed as the most recent and before that, two in 2005 and one in 2000. All staff should receive a minimum of six in twelve months. Likewise staff are receiving formal supervision and records are detailed and accountable showing the function of supervision to be met. Sampling records for two staff members shows that supervision frequency for staff is falling short of the nationally required minimum standard. The Manager carries out all the staff supervisions, as she likes to have this contact and connection with staff. However the need to delegate some of the load was discussed. This will enhance and validate the role of senior staff and will support the manager to ensure that all staff are supervised sufficiently. Staff meetings take place. Records were available for two in 2007. They show that practice issues are discussed and addressed. There was difficulty in locating some of the required safety records but eventually all those requested including environmental risk assessments and service documentation were provided. Steps are taken to minimise environmental risk and as stated the regulatory enforcing authority for health and safety is yet to make a final decision about the death of a service user in November 2006. A third of the staff group are trained in first aid and the manager needs to renew her first aid training. The main areas of environmental concern arising from this inspection are omissions in bed rail safety discussed earlier and a range of shortfalls in fire safety identified by the fire officer in September 2007. Action taken in respect of these is due to be re inspected by the Fire Officer after 14 October 2007. Some steps are in place to help the service to monitor the quality of service it provides. The provider carries out detailed regulation 26 visits and it is positive that service user views are canvassed, collated and analysed. These however are disjointed on their own and a holistic tool is needed to help managers to appraise all aspects of service against the national minimum Coton House DS0000020885.V349496.R01.S.doc Version 5.2 Page 25 standards, regulations and nationally recognised good practice for elders and dementia care. The quality of the homes AQAA (annual return to CSCI) demonstrates how the home is not yet accustomed to self-appraisal. Significant events where improvement must be demonstrated (e.g. fire safety compliance) were not referred to. Achievements quoted within the document, that the Inspector chose to sample such as person centred training and monthly care plan reviews have not and are not taking place. It is important that this legal document is accurate. Coton House clearly has strengths. People are not admitted until the manager assures herself that the home can meet the applicant’s current needs, recognised changes in health are acted upon, residents enjoy their meals, steps are taken to minimise many environmental risks and there is a low turnover of staff. The home must seek to consistently attain high standards of care at all times for all residents and to do so it must ensure that staff receive sufficient guidance, that care is regularly reviewed, that dignity is prioritised for all service users who must be treated individually and yet must be equally valued. The development of person centred care plans, the provision of person centred training for staff, increased staff supervision and the development of a more robust joined-up quality assurance framework will all support Coton House to achieve this. Coton House DS0000020885.V349496.R01.S.doc Version 5.2 Page 26 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 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Coton House DS0000020885.V349496.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Steps must be taken to develop person centred care plans that reflect all areas of assessed need and provide information in sufficient detail to guide how each resident’s needs in respect of health and welfare are to be met. New requirement arising from this key inspection October 2007. Timescale for action 31/12/07 2 OP8 12 Steps must be taken to assess and identify those service users who are at risk of developing pressure sores. Appropriate intervention must be taken to minimise the risk of pressure sores developing and this must be recorded in the individual’s plan of care and reviewed on a continuing basis. This will protect residents from risk to their health. New requirement arising from this key inspection October 2007. 30/11/07 3 OP9 13(2) Medication management must be 31/10/07 reviewed to ensure that: DS0000020885.V349496.R01.S.doc Version 5.2 Page 28 Coton House Medication Administration Records account for the numbers of tablets / dose administered when there is a choice e.g. ‘one or two tablets as required’ And; Stocks of prescribed medication are available at all times for all residents and are not permitted to run out. This will ensure that medication stocks can be accounted for, that amounts of medication administered to service users are known to avoid the risk of under or overdosing. Appropriate stock control will promote service users health and well being by enabling them to take medications as prescribed. New requirement arising from this key inspection October 2007. 4 OP29 19 The registered person must not employ a person to work at the care home unless full and satisfactory information compliant with regulations and Department of Health guidelines has been obtained. This will ensure that risk to residents from new staff is minimised. New requirement arising from this key inspection October 2007. 18/10/07 5 OP38 13(5) Suitable arrangements must be made for the training of staff in first aid and in the meantime the current situation should be risk assessed. 31/03/08 Coton House DS0000020885.V349496.R01.S.doc Version 5.2 Page 29 This will ensure that staff are trained to respond appropriately in the event of an accident or incident. New requirement arising from this key inspection October 2007. 6 OP38 23(2)(c) Steps must be taken to minimise the risk of injury to service users from the use of bedrails. Ill fitting bedrails can cause residents limbs to become entrapped and can result in severe injury or death. Developed safety systems will ensure that bed rails can be safely used to protect residents from falling from bed. (It was agreed with the provider that this was a priority and would be addressed on the day of inspection.) New requirement arising from this key inspection October 2007. 18/10/07 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 reviewed to reflect the range of needs (i.e. mild dementia) that the home intends to provide for and should include all information required under amendments to regulations. New recommendation arising from this key inspection October 2007. 2 OP10 Arrangements should be made to ensure that the care home is conducted in a manner, which respects the privacy, and dignity of residents at all times. This shall include particular regard to personal care giving and shall exclude the practice of group personal grooming and DS0000020885.V349496.R01.S.doc Version 5.2 Page 30 Coton House group personal grooming with shared equipment. New recommendation arising from this key inspection October 2007. 3 OP12 Up to date information about planned activities should be circulated to all residents in formats suited to their capacities. New recommendation arising from this key inspection October 2007. 4 OP30 Staff should be provided with training in person centred planning and person centred care. New recommendation arising from this key inspection October 2007. 5 OP31 A training need analysis should be carried out in respect of the Manager with an action plan to address any training needs identified. New recommendation arising from this key inspection October 2007. 6 OP36 Supervision systems should be reviewed to ensure that all staff including the Manager receives a minimum of 6 supervisions a year. New recommendation arising from this key inspection October 2007. Coton House DS0000020885.V349496.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Shrewsbury Local Office Commission for Social Care Inspection 1st Floor, Chapter House South Abbey Lawn Abbey Foregate Shrewsbury, SY2 5DE 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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