Inspection on 29/04/05 for Cotswold House

This inspection was carried out on 29th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cotswold House 18/06/08

Cotswold House 13/04/06

Cotswold House 05/10/05

Cotswold House 16/09/04

Cotswold House 04/05/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE COTSWOLD HOUSE 178 Cotswold Avenue Duston Northampton NN5 6DS Lead Inspector Pat Harte Unannounced 29th April 2005 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. COTSWOLD HOUSE C51 S34924 Cotswold House V217164 290405 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cotswold House Address 178 Cotswold Avenue Duston Northampton NN5 6DS 01604 751436 01604 591506 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) Mr Philip Jones, Northants County Council, Oxford House, West Villa Road, Wellingborough, Northants NN8 4JR Mrs Gabriella OKeeffe CRH 42 Category(ies) of PD(E) Physical Disabiliry over 65yrs - 5 places registration, with number DE(E) Dementia over 65yrs - 17 places of places OP Old Age - 42 places COTSWOLD HOUSE C51 S34924 Cotswold House V217164 290405 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: No person falling within the OP category can be admitted where there are already 42 people of OP category already in the home No person falling within the DE(E) category can be admitted where there are already 17 people of DE(E) category already in the home No person falling within the PD(E) category can be admitted where there are already 5 people of PD(E) category already in the home To be able to accommodate 2 named service users who have needs within the MD(E) category Total number of service users in the home must not exceed 42 Date of last inspection 16th September 2005 Brief Description of the Service: Cotswold House is residential care home providing personal care for up to 42 Elderly Residents, including 17 people with Dementia and 5 people with Physical Disabilities. The Home has a specific condition to provide care for 2 existing, named Residents with Mental Disorders. The Home is owned by Northamptonshire County Council.The Manager is Mrs. G. OKeefe. The Home is situated in a residential suburb of Duston in Northampton close to nearby shops. The Premises consist of a 2 storey building providing lounge/dinning areas on both floors. The first floor is accessible by a lift. Single bedrooms are provided for all Residents. The Home provides pemanent care only. COTSWOLD HOUSE C51 S34924 Cotswold House V217164 290405 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for Service Users and their views of the service provided. The primary method of inspection used was ‘case tracking’ which involved selecting 3 Residents and tracking the care they receive through review of their records, discussion with them, the care staff and observation of care practices. 5 staff and 13 Residents were spoken with. Mostly positive written comments were also received from 12 Residents but there were some criticisms on the variety of food provided. 11 Relatives provided written comments again mostly positive but 6 felt there were insufficient staffing levels. 9 positive comments were received from visiting Medical Practitioners. A partial tour of the premises took place and a selection of records was inspected. The Inspection took place during the late morning and afternoon over a period of 5 hours and was carried out on an unannounced basis What the service does well: What has improved since the last inspection? Considerable redecoration and replacement of furniture and carpets has taken place, providing Residents with a comfortable and homely environment. COTSWOLD HOUSE C51 S34924 Cotswold House V217164 290405 stage 4.doc Version 1.30 Page 6 What they could do better: 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. COTSWOLD HOUSE C51 S34924 Cotswold House V217164 290405 stage 4.doc Version 1.30 Page 7 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 COTSWOLD HOUSE C51 S34924 Cotswold House V217164 290405 stage 4.doc Version 1.30 Page 8 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, 2, 3, 4 &5 Documentation provided to Prospective Residents is in need of revision to provide accurate information to enable them to make informed choice regarding their placement and the pre-admission assessment process needs to be more detailed to provide accurate information on needs. EVIDENCE: Information given to Residents, including the Home’s Statement of Purpose, is currently being revised to accurately reflect the Home’s services, facilities and Aims and Objectives. The admission process ensures that all prospective Residents are visited and assessed by staff from the Home. Individual records are kept for each of the Residents and inspection of the records showed that the pre-assessment documentation was somewhat limited and did not provide detailed information and risk assessments on all the needs to be met, particularly in the area of Dementia needs. Residents are provided with contracts, these are currently under revision. COTSWOLD HOUSE C51 S34924 Cotswold House V217164 290405 stage 4.doc Version 1.30 Page 9 Residents and their relatives have opportunities to visit the Home before admission. Residents spoken with felt that staff were aware of their general needs and the care to be provided at the point of their admission to the Home. Staff spoken with felt that they were given information on new Residents needs, routines and wishes. COTSWOLD HOUSE C51 S34924 Cotswold House V217164 290405 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, 9 & 10 Little progress has been made in the development of Care plans to adequately provide staff with detailed information they need to fully met the Residents needs. EVIDENCE: Individual plans of care are available for all Residents. The plans inspected showed that account is taken of Residents wishes and preferred routines. References to personal care needs remained limited. Instructions and guidance for staff on how the care was to be provided was not fully detailed. The approach to Dementia care is still fragmented, as the Home only has one dedicated Dementia care, which is insufficient to provide for up to 17 People with Dementia needs. Information gathering on Life histories, to aid understanding of the conditions and behaviours of Residents with Dementia, was limited and not crossreferenced to the care plans. Strategies for the management of behaviours and anxieties were not detailed. COTSWOLD HOUSE C51 S34924 Cotswold House V217164 290405 stage 4.doc Version 1.30 Page 11 The documentation of Health care needs was also limited in detail though staff showed that they responded quickly to any changes to their Residents’ health and made referrals to medical professionals. The Home’s Medication system was generally well maintained although there were some gaps showing a failure of staff to sign the administration record. Service Users felt that they were treated as individuals and were respected by staff. Staff ensured that their privacy and dignity was protected when personal care was carried out. COTSWOLD HOUSE C51 S34924 Cotswold House V217164 290405 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) 12, 13, 14, 15 Residents are enabled to maintain their independence as much as possible and exercise choice in the way they wish to lead their lives although the activity programme is limited and does not provide suitable and meaningful activities for Residents with Dementia. EVIDENCE: Whilst Residents felt they had choice and variety in the food provision and their likes and dislikes were respected they commented that they had not been satisfied recently with the quality of some foods. They had raised concerns with the Manager on the poor quality of the bread and the lack of fresh vegetables but were pleased to note that the Manager made immediate changes. The midday meal was efficiently served and nicely presented. Staff helped Residents with their meals where necessary. Residents felt routines were relaxed and flexible and that their preferences on rising and going to bed times were respected. They felt that they were free to decide on how and where they wished to spend their time and were encouraged and supported to retain as much independence as possible. COTSWOLD HOUSE C51 S34924 Cotswold House V217164 290405 stage 4.doc Version 1.30 Page 13 The Home has a limited activities programme. Residents commented that staff had little time to provide for individual interests or just sit and talk with them. There is little in the way of meaningful individual activities for Residents with dementia. The Home has an open visiting policy. Residents confirmed that they were enabled to receive their visitors in private if they wished. COTSWOLD HOUSE C51 S34924 Cotswold House V217164 290405 stage 4.doc Version 1.30 Page 14 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) 16,17 &18 Systems are in place to ensure that complaints are listened to and acted upon and that Residents are protected and their rights are upheld. EVIDENCE: Residents confirmed that they had been given the Home’s complaints procedure which is also displayed in the Home. Those spoken with felt confident and able to raise any issues or concerns with staff. A complaints record is maintained showing that any issues raised are taken seriously, investigated with action taken to improve the service where necessary. On complaint has been received by the CSCI in the last year. The areas of the complaint concerned the inappropriate packing of a Resident’s belongings on discharge from the Home, partially substantiated; that the Resident had a bunch of keys belonging to the Home, substantiated; and that the Resident could not walk after returning from Hospital, not substantiated. The Commission made a requirement for the Home to ensure keys were safely stored and a recommendation to ensure that Resident discharges are conducted in a timely dignified and appropriate way with particular emphasis given to the packing of their belongings. Staff showed that they were familiar with procedures to protect Vulnerable Adults from abuse. COTSWOLD HOUSE C51 S34924 Cotswold House V217164 290405 stage 4.doc Version 1.30 Page 15 Residents are supported to vote and postal votes are obtained. COTSWOLD HOUSE C51 S34924 Cotswold House V217164 290405 stage 4.doc Version 1.30 Page 16 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 - 26 The layout of the Home does not provide sufficient secure and dedicated areas for Residents with Dementia, secure garden areas are also insufficient. EVIDENCE: The Home has one small secure garden suitable for Residents with Dementia, which is insufficient for the overall number. Whilst the front door is secure Residents can access stairwells and some staff areas leading to doors opening to the outside. The fencing to the side service area of the home is broken and there is the potential risk that Residents with Dementia could go missing or gain access to the busy main road through this area. Since the last Inspection there has been considerable renewal of furniture and carpets and some redecoration work. The Home is comfortably furnished, domestic and hygiene maintenance was good. COTSWOLD HOUSE C51 S34924 Cotswold House V217164 290405 stage 4.doc Version 1.30 Page 17 There has been a failure to install Fly screens to the Kitchen windows, an outstanding requirement from the last Inspection. Residents stated their satisfaction in the facilities. They are enabled to personalise their rooms and have their furnishings and belongings about them. COTSWOLD HOUSE C51 S34924 Cotswold House V217164 290405 stage 4.doc Version 1.30 Page 18 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) 27, 28, 29 & 30 Procedures for the recruitment of staff were robust and provided safeguards to offer protection to people living in the Home, however the deployment and number of staff was insufficient to provide monitoring and supervision for Residents with Dementia needs. EVIDENCE: Residents spoken with said that the staff were very kind, committed and caring. Residents and Relatives comments indicated that they felt the Home was short staffed at times and that there were delays in meeting their needs. Staff rotas showed that 5 care staff are on duty on day time shifts with the level dropping to 4 after 5.30pm. There are five lounge areas, which, at times cannot be appropriately supervised and monitored as staff are frequently called away to assist in other areas. 3 care staff provide night cover. Only one dedicated area is provided for Residents with Dementia with others being accommodated throughout the Home. There were times when staff were occupied in other areas and these Residents were not supervised and monitored. The sample of two staff members records inspected showed that the necessary checks and references had been obtained. A sample of staff training records inspected showed that staff receive induction, ongoing training and regular updates. Training on specialist areas is provided but there are still some limitations on Dementia care training. COTSWOLD HOUSE C51 S34924 Cotswold House V217164 290405 stage 4.doc Version 1.30 Page 19 COTSWOLD HOUSE C51 S34924 Cotswold House V217164 290405 stage 4.doc Version 1.30 Page 20 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, 35, 36, 37 & 38 The Manager has failed to take action to ensure the systems for the safekeeping of Residents moneys are maintained in their best interests. EVIDENCE: Staff spoken with felt that the Manager was easily accessible to them and was willing to discuss any issues and guide them in practice. Supervisions systems were in place to ensure that staff receive guidance and support. Residents felt the Manager was readily available to them. They commented that regular Residents meetings were held and that the Manager also sought their individual views. Residents felt that they had trust and confidence in the staff group as a whole. A recent survey, conducted by the Manager, showed that she had sought Residents’ comments and had taken action on areas of concern for example on their dislike of the bread provided and the lack of fresh vegetables. COTSWOLD HOUSE C51 S34924 Cotswold House V217164 290405 stage 4.doc Version 1.30 Page 21 The systems for safekeeping of Residents moneys showed that their moneys are still held in a Local Authority bank account. A previous requirement to ensure moneys are promptly transferred directly to the Resident or paid into individual’s bank accounts has not been met. Receipts for services such as Chiropody showed that all participating Residents were charged the same amount regardless of the treatment they received. Not all entries for withdrawals were signed by either the Residents or by two members of staff. Details of Residents’ bankbooks held for safekeeping were not fully documented. COTSWOLD HOUSE C51 S34924 Cotswold House V217164 290405 stage 4.doc Version 1.30 Page 22 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 2 2 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 2 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 2 3 2 x 2 3 2 2 COTSWOLD HOUSE C51 S34924 Cotswold House V217164 290405 stage 4.doc Version 1.30 Page 23 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. Standard 7 Regulation 15 (1) Requirement Care Plans must have sufficient and up to date information in order that care needs may be met. This is an outstanding requirement from the Inspection Report dated 16.9.04. Timescale by 29.11.2004 An action plan must be submitted with proposals for appropriate accomodation for Residents with Dementia including safe and secure garden areas. The fencing to the side service arres of the Home must be replaced and written confirmation that this has been done forwarded to the Commission. The Registered Persons must comply with the requirement to provide a fly screen in the kitchen and must address the problem of the design of the window in order to facilitate this. This is an outstanding requirement from the Inspection Report of 16.9.2004 Timescale by 29.11.04. Staffing levels must be increasedto meet the needs of Timescale for action 30.6.2004 2. 19 23 (1) (a) & 2(a) 10.6.2005 3. 19 23 (2) (b) 10.6.2005 4. 19 16 (2) (j) & 12 (1) (a) 10.6.2005 5. 27 18 (1) (a) 10.6.2005 Page 24 COTSWOLD HOUSE C51 S34924 Cotswold House V217164 290405 stage 4.doc Version 1.30 6. 35 20(1) (a) the Residents and provide adequate supervision and monitoring. The Registered Person must ensure that money belonging to Service Users is paid into individual bank accounts.This is an outstanding requirement from the Inspection Report of 16.9.2004 Timescale by 15.1.05 30.6.2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 3 35 Good Practice Recommendations The pre-admission assessment documentation should be detailed with written comments on areas of need to aid the development of the care plan. All items held on behalf of Residents for safekeeping should be clearly described and documents. The numbers and type of Bank Accounts held should be recorded and held seperately from the books in order that a stop may be put on accounts should they be stolen or go missing. Amounts should be recorded on deposits and withdrawals. The Manager should ensure that the suppliers of external services such as CHiropody provide itemised invoices for each Resident reflective of the actiual treatment given. 3. 35 COTSWOLD HOUSE C51 S34924 Cotswold House V217164 290405 stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Newland House 1st Floor Campbell Square Northamtpon NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI COTSWOLD HOUSE C51 S34924 Cotswold House V217164 290405 stage 4.doc Version 1.30 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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