CARE HOME ADULTS 18-65 Cotswold Cottage Grange Road Hazlemere High Wycombe Bucks, HP15 7QZ
Lead Inspector Chris Schwarz Announced 04 May 2005 09:15 a.m. The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cotswold Cottage Version 1.10 Page 3 SERVICE INFORMATION
Name of service Cotswold Cottage Address Grange Road, Hazlemere, High Wycombe, Bucks, HP15 7QZ 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) 01494 527642 The Fremantle Trust Diane Bryant Care Home 8 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places Cotswold Cottage Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 02 August 2004 Brief Description of the Service: Cotswold Cottage is a detached property located at the end of a quiet residential road in Hazlemere, High Wycombe. The home is run by The Fremantle Trust and is registered to provide accommodation for up to eight people with learning and physical disabilities. The home is near to local shops and public transport links into High Wycombe and Amersham. Cotswold Cottage has eight single bedrooms, some on the ground floor, and two lounge areas. There is a large kitchen/dining area and sufficient bathrooms and toilets. The home has an enclosed garden and overlooks farmland to the rear. Each person living at the home has considerable care needs and the home has appropriate aids and adaptations to assist with daily living tasks. Cotswold Cottage Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced visit took place on a week day from 9.15 am to 5.15 pm. It consisted of discussion with the manager, a tour of the building and examination of some required records. The focus was on management of the home, the environment and staffing issues. Prior to the inspection the home was asked to complete a pre-inspection questionnaire and distribute comment cards to relatives, service users and outside agencies. One relative visited the home to meet the inspector and another had telephone contact the day before. What the service does well: What has improved since the last inspection?
Medication practice is managed more effectively at the home. Staff training has received more attention and some health and safety risks have been reduced, such as preparing generic risk assessments, adding the fire assembly point to fire posters, safe storage of cleaning products and keeping the boiler room locked. Staff support has improved through more frequent staff supervision and regular staff meetings are taking place. Cotswold Cottage Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cotswold Cottage Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Cotswold Cottage Version 1.10 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Not assessed on this occasion. There have not been any new admissions to the home. EVIDENCE: Cotswold Cottage Version 1.10 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Not assessed on this occasion. These standards will be the focus of unannounced visits to the home. EVIDENCE: Cotswold Cottage Version 1.10 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 17 The home provides a range of meals and meal supplements to meet service users’ nutritional needs. There are insufficient records at the home, so that individual service users’ preferences cannot be demonstrated. EVIDENCE: A couple of relatives expressed concern at food provided for service users, commenting on processed food being served on one occasion and insufficient planning of meals, resulting in poor choice of food being given to a service user. The home does indeed use occasional processed items, such as pork pies, to reflect one person’s preference. Menus were being revised at the time of this visit and the manager was aiming to allow for greater flexibility to reflect choices and deal with eating and swallowing difficulties. The lack of detailed records of food consumed by service users could not wholly back up the home’s claim that it is flexible in meeting individual choices and a requirement is set to maintain accurate records in this area. Unannounced visits to the home will be timed to include meal times to look at this standard in more detail.
Cotswold Cottage Version 1.10 Page 11 Cotswold Cottage Version 1.10 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 20 The home effectively manages service users’ medication, to keep them healthy and well. Service users are enabled to receive advice and treatment from a range of health care professionals, to keep them well. EVIDENCE: The home uses a monitored dose system of medication administration and receives regular visits form the pharmacy to check storage and answer any queries. There was evidence of staff receiving training on medication administration since the last inspection and records of drugs administered to service users were well maintained. Storage of medication was mostly satisfactory although there is a free-standing small cabinet in the medication room which should be secured to the wall as an added safeguard. Guidance on the use of rectal diazepam is in place for seizure management. Records of medical appointments were looked at and showed that service users receive input from a range of health care professionals, such as dieticians, a physiotherapist, speech and language therapists and district nurses. Some routine health screening appointments were overdue, although arrangements have been made for these to be brought up-to-date. Cotswold Cottage Version 1.10 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 There is a complaints policy in place to listen to the views of service users or their representatives. Some complaints have been handled satisfactorily whilst others need more work. Adult protection is appropriately managed to keep service users safe from harm. EVIDENCE: There is a complaints procedure although this needs to be updated to reflect that CSCI is the regulatory body. A requirement is made to attend to this. The complaints log showed that various complaints have been made regarding care and environmental issues. Some of these complaints have arisen for a second time. One relative felt intimidated that the home had expressed disappointment at contacting the inspector directly with some issues of concerns. The home has adult protection and whistle blowing policies in place and inhouse training has taken place for most of the staff team. The remainder of staff will need to receive training also – see general training requirement under standard 35. Cotswold Cottage Version 1.10 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28, 29 and 30 The home is attractively arranged and decorated to provide a stimulating and pleasant environment for service users. There is poor response from the landlords to maintain the environment, causing inconvenience and discomfort to service users. EVIDENCE: The home is well presented and is indistinguishable in the road as a care home. It has extensive views over farmland and is within a few minutes walk of local shops and public transport links. All bedrooms are single and have been decorated and arranged to reflect individual tastes and personalities. Some redecoration is planned to enhance bedrooms that need a little refreshing and the hallways and corridors are also due to be repainted. Communal rooms are light and airy and have been decorated and arranged in keeping with a large family type dwelling. The kitchen and laundry are of adequate size for the number of service users and were clean and in good order, as was the rest of the home. Cotswold Cottage Version 1.10 Page 15 There are sufficient toilets and bathrooms at the home and these have been adapted to assist service users with physical disabilities. There was an issue with one piece of equipment, a shower chair, which needs a footplate; this was taking an excessive amount of time to be ordered. A requirement is being made for the home to attend to this straightaway and supply details of when the footplate is in place. A relative complained about the length of time taken to replace a bedroom carpet ruined by a leaking radiator. The home has historically faced difficulties with the landlords attending to maintenance issues and this was another example; the manager had not been informed of the landlord’s change of address and contact details for reporting any maintenance problems. The Commission will meet with representatives of The Fremantle Trust to discuss a constructive way forward with the landlords, to ensure that any maintenance matters are attended to promptly. Cotswold Cottage Version 1.10 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34, 35 and 36 There are effective recruitment practices and staff support systems to keep service users safe and ensure that they are cared for by a competent staff team. Training is receiving a higher priority, to ensure that skilled and knowledgeable staff provide care to service users. There are continuing problems in recruiting staff which may mean that service users’ care sometimes suffers through use of agency staff. EVIDENCE: There were around 110 vacant staff hours with another 22 becoming available the following week. The home has used relief and agency staff to cover gaps in the rota and some consistency has been achieved, given difficult circumstances. A recommendation is being made to supplement rotas with the first and surnames and supplying agency. Some relatives considered that care sometimes suffered when agency staff are on the rota, as attention to detail was not as thorough as the home’s permanent staff. Some background checks were being made of three prospective staff and a fourth person was being considered. The home has experienced long term difficulties in recruiting staff and relatives and existing staff are hopeful that new people will be attracted to work at Cotswold Cottage. Recruitment checks of a new relief worker were satisfactory and information supplied by the agency was in good order.
Cotswold Cottage Version 1.10 Page 17 Rotas showed that satisfactory levels of staff are being maintained although some relatives pointed out that there is restricted scope for taking service users out. The lifestyle standards were not assessed on this occasion, but it was noticed that additional staff had been rostered to work on the day of the inspection to take service users out to a karaoke evening. Most of the staff have up-to-date training, according to records. There was a noticeable improvement in this area of practice with mandatory, National Vocational Qualifications and health-related courses all featuring. An offer by a NHS dentist to provide some free oral care training should be taken up, to supplement a recent course and help overcome a complaint about staff not cleaning teeth consistently. Some staff, mainly reliefs, need to bring their training up-to-date or attend first time training and the home will need to ensure that everyone has attended adult abuse training. A requirement is set to address this. Supervision was taking place fairly regularly, according to a random selection of four staff files. There is a new induction format, which needed just a small piece of addition – to ensure that staff know about notifiable incidents and how to report these, added during the inspection. There has not been occasion to use this format yet. Staff meetings have been taking place regularly, according to minutes. One relative commented, “I am very happy with the quality of care provided for my daughter at Cotswold Cottage. I was particularly touched that her key worker was thoughtful enough to help her send me a Mother’s Day gift. All the staff have helped her fully recover from serious illness.” Another relative said, “We are very pleased with the liaison between the home and day centre.” Another relative said, “Many staff do their best and certainly care for my daughter. I think they have a very difficult job.” Cotswold Cottage Version 1.10 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 and 42 There is effective monitoring by the provider to ensure that service users receive the care they require. Health and safety needs more attention to ensure that service users, staff and visitors are not placed at risk of injury of harm. EVIDENCE: Regular monitoring visits are undertaken by the provider with reports of these visits available at the home and also forwarded regularly to the Commission. A quality assurance exercise took place in February this year with a overall score of 92 ; a second care audit is booked for later in the year. A range of health and safety checks is undertaken at the home including fridge and freezer temperature checks, core food temperature checks and visual hazard checks around the building. One complaint focussed on excessively hot water in a service user’s bedroom and this has received attention and more frequent temperature monitoring. Both taps in the bedroom were working effectively on the day of the inspection.
Cotswold Cottage Version 1.10 Page 19 The fire log provided evidence of regular checks to safeguard against the risk of fire. The home’s fire based risk assessment needs to be reviewed as it was produced in 2003 and needs annual reviewing; a requirement is set to attend to this. An environmental health inspection took place in December 2004 with satisfactory findings. Generic risk assessments are up-to-date and there are certificates of gas and electrical hardwiring safety. Risk assessment for the use of the gas fires has not been completed and one on the use of mats on the patio needs some additional wording. One repeated requirement and a recommendation are therefore made. Cleaning products are stored safely and there are product safety information sheets in the event of accidents. There has been some improvement to clinical waste disposal bins although the upstairs bathroom bin remains a risk with the contents easily accessible. A requirement is set again regarding this. SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3
Cotswold Cottage Score x x x Standard No 22 23 Score 2 3 Version 1.10 Page 20 4 5 x x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score x x x x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 3 2 3 Standard No 11 12 13 14 15 16 17 x x x x x x 2 Standard No 31 32 33 34 35 36 Score x x 3 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 2 x Cotswold Cottage Version 1.10 Page 21 yes 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. 2. 3. 4. 5. 6. Standard 17 22 29 35 42 42 Regulation schedule 4 (13) 22(7)a 23(2)n 18(1)c(1) 23(4) 13(4) Requirement Accurate records must be maintained of food consumed by service users. The complaints procedure must be updated to reflect the change of regulator to CSCI. The shower chair footplate must be ordered and date of delivery notified to CSCI. Up-to-date mandatory training, including adult protection, must be in place for all staff. An up-to-date fire based risk assessment must be in place. A risk assessment must be prepared on the use of the gas fires (previous timescale of 03 September 2004 not met). Clinical waste bins must have non-return lids in order that the contents are not accessible to service users (previous timescale of 15 September 2004 not met). Timescale for action from 05 May 2005 by 05 June 2005 from 05 May 2005 by 05 October 2005 by 05 June 2005 by 05 June 2005 by 05 June 2005 7. 42 13(4)c RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Cotswold Cottage Version 1.10 Page 22 No. 1. 2. 3. 4. Refer to Standard 20 33 35 42 Good Practice Recommendations The free-standing medication cabinet should be secured to the wall. Rotas should state the first and surnames of any agency staff and which agency supplied them. Further training on oral care should be undertaken. The risk assessment on the use of mats on the patio should include a statement that staff are to supervise service users when outside, to minimise risk. Cotswold Cottage Version 1.10 Page 23 Commission for Social Care Inspection Cambridge House, 8 Bell Business Park, Smeaton Close Aylesbury Bucks, HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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