Inspection on 05/10/05 for Cotswold House

This inspection was carried out on 5th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 29/04/05

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 Northants NN5 6DS Lead Inspector Mrs Pat Harte Unannounced Inspection 5th October 2005 10:00 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 Cotswold House DS0000034924.V253072.R01.S.doc Version 5.0 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. Cotswold House DS0000034924.V253072.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Cotswold House Address 178 Cotswold Avenue Duston Northampton Northants NN5 6DS 01604 751436 01604 591506 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) Northamptonshire County Council Mrs Gabriella Katrina O`Keeffe Care Home 42 Category(ies) of Dementia - over 65 years of age (17), Old age, registration, with number not falling within any other category (42), of places Physical disability over 65 years of age (5) Cotswold House DS0000034924.V253072.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 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 29/4/05 Brief Description of the Service: Cotswold House is a 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 an additional specific condition to provide care for 2 existing Residents with Mental Disorders. Northamptonshire County Council owns the Home. The Manager is Mrs. G. OKeefe. The Home is situated in a residential suburb of Duston in Northampton close to nearby shops and is easily accessible by public transport. The Premises consist of a 2-storey building providing lounges/dinning and bedroom areas on both floors. The first floor is accessible by a lift. Single bedrooms are provided for all Residents. The Home provides permanent care only. Cotswold House DS0000034924.V253072.R01.S.doc Version 5.0 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. Inspection planning took 1 hour and consisted of a review of the last inspection report and the Home’s service history including notifications and events. 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, talking with them and the care staff. In addition 3 staff and 7 Residents were spoken with and care practices were observed. A partial tour of the premises took place and a selection of records was inspected. Discussions were held with the Registered Manager. 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? The assessment processes have been revised to ensure that all areas of need are identified and that these needs can be met. Cotswold House DS0000034924.V253072.R01.S.doc Version 5.0 Page 6 Attention has been paid to the development of Life Histories for all Residents but particularly those with Dementia. The information enables staff to have a better understanding of the individual’s needs, informs then of things that are important to the Individuals and in the case of Residents with Dementia promotes more effective understanding, communication and interaction between Residents and staff. Care plans have been revised and showed a more holistic approach with an increased level of instruction and guidance for staff on how the physical care needs are to be met. Dedicated areas for Residents with Dementia have been developed with their own staff group. This provides a greater continuity and consistency of care for those Residents and ensures that familiar staff are on hand and are able to provide constant monitoring and supervision. Residents stated that the activity provision had improved and increased staffing levels meant that staff were able to spend time talking with them. Systems for the safekeeping of Residents monies and valuables have been reviewed. The systems are now regularly audited and securely maintained. Excess money is routinely transferred to individual Resident’s bank accounts to ensure that they receive interest. 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 DS0000034924.V253072.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Cotswold House DS0000034924.V253072.R01.S.doc Version 5.0 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 the following standard(s): 1, 2, 3, 4, 5 & 6 Prospective Residents are provided with information to enable them to make informed choices regarding their placements. The pre-admission assessment is thorough and effective in ensuring that the needs of people admitted to the home can be met. EVIDENCE: The admission process ensures that all prospective Residents are visited and assessed by staff from the Home to identify their individual needs and ensure that these can be met. Residents and their relatives have opportunities to visit the Home prior to their admission and are given written information on the services and facilities. Residents spoken with felt that staff were well briefed on their needs and the care to be provided. Staff spoken with felt that they were given good information on their Residents needs, routines and wishes. Cotswold House DS0000034924.V253072.R01.S.doc Version 5.0 Page 9 Individual records are kept for each of the Residents and inspection of a new Resident’s records showed that the assessment process has been revised to ensure a good level of detail on the individual’s needs. Life history information is gathered for all Residents. Particular emphasis is now placed on the gathering of this information relating to those Residents with Dementia to assist staff in understanding their needs and ensure effective communication and interaction. Specific and recognised assessment tools are used to identify needs and risks as part of the assessment process. Residents are provided with written contracts with copies maintained in their records. Cotswold House DS0000034924.V253072.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 9, 10 & 11 Progress has been made in the development of Care plans to provide instructions and guidance to staff on how the physical care needs are to be met, the development of plans and strategies for the management of behaviours in relation to Resident’s with Dementia is on going. EVIDENCE: Care plan formats have been reviewed and currently about 60 of the plans have been updated to the new format. Records showed a more holistic approach is now being taken in relation to physical and personal care needs. The level of instruction and guidance given to staff has been increased on how the care is to be carried through. However there are still gaps in the instructions such as the timings for specific areas of personal care or the specific equipment to be used e.g. bathing arrangements. The care plans are written in the first person and showed that account is taken of Residents wishes and preferred routines for example “I wish staff to check on me during the night”, “I like to get up at 7.00am”. Cotswold House DS0000034924.V253072.R01.S.doc Version 5.0 Page 11 Care plans also detailed tasks that Residents’ could undertake for themselves showing that they were encouraged to retain as much control over their lives and maintain their independence as much as possible. Attention has been paid to developing sufficient dedicated units for Residents with Dementia for the total number of 17 Residents. A second unit for Residents with Dementia needs is being renovated and is due to become operational shortly. Dedicated staff are now assigned to the units to provide continuity and consistency of care and ongoing monitoring and supervision. Dementia care planning is on going. Attention has been paid to ensuring information gathering on Life Histories for Residents in general with specific attention given to those Residents with Dementia. Staff commented that the information gave them a better understanding of needs and enabled them to communicate more effectively with their Residents. Some cross referencing from the Life Histories was made on the individual care plans but the Manager is aware that further development is needed to provide a good level of guidance to staff on strategies for the management of behaviours and the support to be given to the Residents. Improvements have been made to detailing Health care needs. Residents commented and records showed that staff responded quickly to any changes to their Residents’ health and made referrals to the appropriate Medical Professionals. However, one care plan viewed showed that a Resident had Diabetes but there were no specific instructions on how staff were to monitor the condition. The Manager agreed that further development is needed to ensure specific instructions for staff on any monitoring required. The Home’s Medication system was well maintained with the appropriate procedures in place. The required records for incoming, administration and disposal of medication were in good order. Attention has been paid to ensure no gaps in the administrations records occur. Medication storage was appropriate although there was an oversight when medication to be disposed of was momentarily left unattended in an office. The Manager quickly rectified the situation and reminded staff of the potential risk. Residents commented that they felt they were respected and valued as individuals by staff. Observations confirmed that Staff ensure the protection of Residents privacy and dignity when carrying through personal care. Cotswold House DS0000034924.V253072.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 14 & 15 Residents are enabled to maintain their independence as much as possible and exercise control and choice in the way they wish to lead their lives. Progress has been made in developing the general activity programme however the development of individual and meaningful activities for Residents with Dementia is ongoing. EVIDENCE: Residents stated that 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 and control over their lives. The Home has an open visiting policy. Residents confirmed that they were enabled to receive their visitors in private if they wished. A visiting Relative spoke of always being made welcome and extended hospitality. He stated that staff made time to discuss his Resident’s care needs and that he was kept well informed of any changes or concerns. Cotswold House DS0000034924.V253072.R01.S.doc Version 5.0 Page 13 Residents were satisfied with the food provision and felt that previous issues about the quality of some foods such as bread and the lack of fresh vegetables has been addressed. They stated that staff were fully aware of their likes and dislikes and that they were offered a good level of choice at each meal. Vegetarian meals are available, arrangements can be made to provide for cultural preferences and alternatives to the main menus were confirmed as always available. Hot food choices are available for the evening meal and Residents are provided with cooked breakfasts if they so wish. Observations of the mid day meal confirmed the meal was nicely presented and staff were on hand to assist Residents 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. Residents commented that improvements have been made to the general activities provision and that staff made time to sit and talk with them. Improvements were also noted to the provision of activities for Residents with Dementia. Staff are now allocated to the dedicated units and are able to provide suitable general activities. Discussions confirmed that some individual, meaningful activities were provided but specific instructions were not recorded on the care plans. More use of life history information could be utilised to design individual activity programme. This is an area for ongoing development Cotswold House DS0000034924.V253072.R01.S.doc Version 5.0 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 the following standard(s): 16 & 18 Systems are in place to ensure that complaints are listened to and acted upon and that Residents are protected from abuse. 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. One 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. Action has been taken by the Manager to address the issues raised in this complaint. The record showed that one other complaint had been raised concerning the refusal of the Home to re-admit a Resident following a Hospital Discharge. The Service Development Manager investigated this complaint. The needs of the Resident could not be met by the Home and a further placement was sought. Cotswold House DS0000034924.V253072.R01.S.doc Version 5.0 Page 15 Robust procedures for the Protection of Vulnerable Adults are in place. Staff demonstrated, through discussions, their full understanding of the reporting procedures. Cotswold House DS0000034924.V253072.R01.S.doc Version 5.0 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 the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 Improvements to the layout of the Home have been made with dedicated living areas and secure gardens provided for Residents with Dementia, however there is still a considerable risk that Residents with Dementia may leave the building unnoticed by staff with the potential for them coming to harm. EVIDENCE: Considerable maintenance work has been carried out at the Home for example replacement of some windows in some Resident areas to exclude draughts. The kitchen window has also been replaced to enable the fitting of the fly screens to be carried out shortly. Fencing has been erected to provide safe and secure garden areas for the two units dedicated to Residents with Dementia. However there is still the potential risk that Residents may leave the building unnoticed by staff through a variety of exits such as fire doors and the rear service area. There has been one instance of this occurring with a Resident crossing the road and then sustaining Cotswold House DS0000034924.V253072.R01.S.doc Version 5.0 Page 17 injuries from a fall. There is a further potential risk that Residents may access stairwells unnoticed with the potential for falls. It is acknowledge that repairs to the fencing at the rear of the home are being addressed. The fencing remains hazardous and a revised timescale for the completion of the repairs has been made. Residents confirmed their satisfied with the facilities. They stated their rooms were comfortable and suitable for their needs and they are enabled to personalise the rooms and have their furnishings and belongings about them. The standards of domestic and hygiene maintenance were good and the Home was warm, clean and comfortable. Observations confirmed that Toilet and Bathroom were hygienically maintained. Comments made by a visiting relative and discussions with staff members showed that the Stand-aid provision is insufficient to meet Residents’ movement and handling needs. The Manager agreed to address this area. Cotswold House DS0000034924.V253072.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 28 Sufficient numbers of care staff are deployed to meet the needs of current Residents. EVIDENCE: Residents spoken with said that the all the staff, including ancillary staff, were very kind, committed and caring. They felt that care-staffing levels had improved particularly in the afternoons and stated that staff responded quickly to their needs. Staffing levels have been increased to 5 carers on all daytime shifts and three care staff provide night cover. The revised staffing levels and deployment of staff to dedicated areas ensures good levels of supervision and monitoring. In addition to the care staff, domestic and catering staff are employed together with a Handyman. The ancillary staff provision ensures that care staff are not diverted from their care duties. Cotswold House DS0000034924.V253072.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33 & 35 The Management of the Home is effective and in the best interests of the Residents. Safe systems are in place for the management of Residents monies and items held for safekeeping. EVIDENCE: Staff spoken with felt that the Manager was easily accessible to them and was willing to discuss any issues, guide them in practice and offer support and supervision. Residents felt the Manager was readily available to them. They commented that regular Residents meetings were held and that the Manager consulted with them and sought their individual views and opinions. Residents felt that Cotswold House DS0000034924.V253072.R01.S.doc Version 5.0 Page 20 they had trust and confidence in both the Manager and the staff group as a whole. The systems for safekeeping and management, where necessary, of Residents moneys have been reviewed. Cash held by the Home on behalf of Residents is kept to a minimum with excess amounts transferred regularly to Residents individual bank accounts so that interest may be accrued. Individual receipts for items purchased by staff on behalf of Residents and receipts for services such as Chiropody were maintained. Records of all transactions were well maintained and are subject to regular audits to ensure accuracy. The record systems for the safekeeping of Residents valuables demonstrated appropriate receipting and full documentation. Cotswold House DS0000034924.V253072.R01.S.doc Version 5.0 Page 21 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 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 Standard No Score 16 3 17 X 18 3 2 3 3 2 3 3 2 3 STAFFING Standard No Score 27 3 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X X Cotswold House DS0000034924.V253072.R01.S.doc Version 5.0 Page 22 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 OP19 Regulation 23 (2b) 13 (4a) Requirement The fencing to the rear service areas of the Home must be replaced and written confirmation that this has been done forwarded to the Commission. This area was the subject of a previous requirement with timescale 10.6.05 Proposals detailing the action together with timescales for any work to be carried through to ensure that Residents cannot leave the premises unnoticed must be forwarded to the Commission. Timescale for action 20/11/05 2 OP19 12 (1) (a) 13 (4) (a) 20/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cotswold House DS0000034924.V253072.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton 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 DS0000034924.V253072.R01.S.doc Version 5.0 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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