Inspection on 11/01/09 for Cotswold Spa Retirement Residence

This inspection was carried out on 11th January 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cotswold Spa Retirement Residence 09/02/08

Cotswold Spa Retirement Residence 25/05/07

Cotswold Spa Retirement Residence 23/05/06

Cotswold Spa Retirement Residence 06/12/05

Cotswold Spa Retirement Residence 05/10/05

Cotswold Spa Retirement Residence 16/06/05

Cotswold Spa Retirement Residence 22/11/04

Cotswold Spa Retirement Residence 09/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Cotswold Spa Retirement Residence Station Road Broadway Worcestershire WR12 7DE     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Dianne Thompson     Date: 1 1 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Cotswold Spa Retirement Residence Station Road Broadway Worcestershire WR12 7DE 01386853523 01386852403 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Cotswold Spa Retirement Hotels Limited (wholly owned subsidiary of Four Seasons Healthcare Ltd) care home 20 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The home may accommodate upto 3 service users with a physical disability between the ages of 60 - 65 years. Date of last inspection Brief description of the care home Cotswold Spa is located in the village of Broadway. The home is in an older building (previously used as a hotel) converted for use as a care home. It is on a bus route, and has a garden that can be used by service users, although full access is not possible for people who are less mobile. Cotswold Spa provides nursing care services for older people with accommodation to the three floors. There are 18 single bedrooms and one double occupancy bedroom. Access to each floor is gained by a central passenger lift or by using a staircase. There are two communal lounges and a communal dining room. Information regarding the service can be obtained from the Statement of Purpose and the Service Users Guide, that are available in the reception area. Copies of the Inspection reports are available on request from the person in charge. Cotswold Care Homes for Older People Page 4 of 34 Over 65 20 20 0 0 Brief description of the care home Spa Retirement Hotels Ltd, a member of Four Seasons Health Care, who leases the building from a landlord, provides the care service. The regional manager with responsibility for the service is Ms Karen Houghton and the operational director and responsible individual for the registered provider is Pauline Lawrence. The registered manager has left and the current manager has been in post since June 2008 and is to make an application to become registered with the Commission for Social Care Inspection. Information about the fees is not included in the Service User Guide but is available on request to the regional manager. Additional charges are made for hairdressing, newspapers and chiropody. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection to see what the service was like for the residents of Cotswold Spa Retirement Residence. The date of the last inspection carried out for this service was 09/02/2008. A key inspection looks at all essential aspects of operating a care home. This type of inspection looks for evidence that shows continued safety and positive outcomes for people who use the service. This inspection took place throughout the day on 11th January 2009. The manager was present during the inspection and along with various members of the staff team, provided assistance during the visit. The manager completed an Annual Quality Assurance Assessment (AQAA) and sent this Care Homes for Older People Page 6 of 34 to the Commission for Social Care Inspection (CSCI). The AQAA is where the manager tells us about the service provided at Cotswold Spa Retirement Residence and how they plan to develop the service. Three residents were identified for close examination by reading their care plans, risk assessments, daily records and other relevant information. This is part of a process known as case tracking where evidence of the care provided is matched to outcomes for residents. Time was spent talking to some residents, visiting relatives and some staff working there. We looked to see whether residents were being kept safe and how the service listen to residents views about their life at the Cotswold Spa Retirement Residence. We saw how staff spoke to and supported residents, such as mealtime and the administration of medication. We looked round the home to see what the standard of accommodation was like. What the care home does well: What has improved since the last inspection? What they could do better: There should be enough staff on duty at all times to meet all the needs of all residents. Care Homes for Older People Page 8 of 34 A number of staff left the service since the last inspection. The manager is recruiting new staff to the team and hopes to complete this recruitment campaign, soon so that the service has a full complement of staff. Management should take appropriate action to ensure that at all times suitably qualified, competent and experienced people work at the care home. The staff-training programme should include specialist dementia care training, so that residents can be confident that suitably trained and qualified staff will be available to meet their needs. Residents should have access and opportunity to take part in a range of therapeutic and social activities suited to their individual needs, preferences and capacities. Residents should benefit from spending time in a stimulating and engaging environment that meets their individual needs and expectations. This will help residents sense of well-being and self esteem. Cotswold Spa Retirement Residence accommodates both male and female residents. As an equal opportunity employer the service also employ both male and female care staff. Residents should be consulted about whether they prefer a male or female carer to support them with their care needs and any preferences they have should be acknowledged, recorded and respected. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Cotswold Spa gives prospective residents and their relatives information about the service they provide. This information aims to help them make a decision about their future care needs and whether the service can meets those needs. An admissions policy and procedure is followed to make sure all needs are fully assessed. Evidence: Cotswold Spa Retirement Residence makes a range of information available about their service that includes their Service User Guide. This information is available to people and their families when considering their future care needs. We saw a copy of the Statement of Purpose that includes the Service User guide, easily accessible on display in the main entrance of the building. The service user guide does not include a copy of the complaints procedure, although information about how to complain is displayed in the main entrance. Details of fees are not given in the Service User guide as required by regulation. Care Homes for Older People Page 11 of 34 Evidence: People who use the service and their relatives confirmed that they had been given a copy of the Service User Guide and other documents, although some people said they were unsure about the information they had been given. One relative explained that they did not understand what the fees covered, and felt that this had not been fully explained to them. For example, they were unsure about buying toiletries for their relative. Another person said they had not been given a copy of the complaints procedure. The manager says in the services AQAA that she follows Four Seasons policy with regard to taking in admissions. Enquirers are invited to visit the home as often as they feel to view and meet with the staff before making their decision. The manager said that she completes a pre-admission assessment for each person to make sure they can provide the service that will fully meet each persons needs. A sample of three residents case records was checked. We saw that for two residents, detailed assessments had been completed before they moved into Cotswold Spa. One residents assessment had not been fully completed. This was discussed with the manager who agreed to follow this up. We saw information from social workers or medical professionals included as part of the pre admission assessment. This gives more specific details about the support needed for each resident, and includes information such as medical history and discharge details from hospital. We saw that weight checks are made on admission to the service that helps staff monitor and observe for any significant weight gain or loss. Risk areas are identified and assessments are completed so that staff will know how to provide the support that is needed to minimize these risks. This includes risks associated with falls and pressure sores. Residents of Cotswold Spa looked clean, well dressed and presented. Visiting relatives indicated that they were happy with the care for their relative and satisfied with their care although some said they were worried about the lack of staff and the number of agency staff who work here. Residents spoken to said they are happy with the care they get and that staff are good. One person said they are too busy to spend time with me. The manager identifies in the services AQAA plans for improvement to the admission process. This will include a profile of all staff provided in the statement of purpose and service user guide to help residents feel more acquainted with staff. The manager confirmed that the service also provides respite care but not intermediate or Care Homes for Older People Page 12 of 34 Evidence: rehabilitative care. Care Homes for Older People Page 13 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service works to care plans that detail each residents personal, health and social care needs to make sure their health and welfare is maintained. Residents can be confident that their health and personal care needs will be assessed, documented, and reviewed. They will also be supported to access a range of health care services to meet their individual needs. Medication practices are safe and residents say they are treated with respect by staff. Evidence: We saw care plans developed from pre admission assessments. The care records belonging to three residents were checked and each one had a plan of care that is regularly reviewed. We saw records to show that residents are involved in the planning, development and review of their care plans. The manager says in the services AQAA that care plans are changing to a different style of assessment. These will improve the care plans and make them more user friendly for the staff and the resident. Care Homes for Older People Page 14 of 34 Evidence: We saw information that details the action to be taken by staff to make sure that all personal, health and care needs are met for the residents. Key workers as well as named nurses, are now assigned to residents . Photographs are being given out so residents and their relatives know who the members of staff are. We spoke to some of the residents, including two residents who were part of the case tracking process. This means that we look at all aspects of care and support each resident receives, including all records relating to medication, diets and menus and other aspects that affects their life at Cotswold Spa. We looked at staff training records to check that staff are trained and experienced to meet the needs of these residents. We saw care plans that consider areas such as moving and handling profiles, social needs, medication, communication, death and dying, pressure sores and risks associated with skin care and falling out of bed. Where people needed continence support we saw information about continence management and the type and size of continence pad to be used. The moving and handling profile includes an assessment of risk that explains the type of support residents need and the correct sling to be used with the hoist. This makes sure that staff use equipment in an agreed, safe and consistent way. Designated staff have been trained to complete these assessments and to train other staff in safe handling techniques. Some profiles include an assessment of risk for people where bed rails are used. We saw bumpers in place where bed rails are being used. One resident said that they had agreed to use the bedrail as it is safer and stops me falling out of bed. We saw evidence that relatives have been involved in the development of care plans and where residents have been unable to do so, relatives have signed the care plans on their behalf. It was noted however, that these forms do not have the facility to be dated when signed or for when changes are made to the care plan. The manager said she would make sure that all care plans are signed and dated. Although the care plans seen provide information to make sure all staff give safe and consistent support to meet everyones needs, there are gaps in the overall assessment that means there are gaps in the planning of care. For example, in two of the care plans examined we found no information about oral care, preferred carers as in male or female care staff giving personal care, preferred routines such as time of getting up in the morning and going to bed at night. There was no personal profile to give details of peoples life prior to moving into the nursing home, such as their history, their likes and dislikes, hobbies, family, previous work career where this was relevant. This was discussed with staff who said this would be helpful. One resident said staff dont talk to them. Staff should have information to help them talk with residents about their Care Homes for Older People Page 15 of 34 Evidence: lives, in a conversational way that extends beyond peoples basic care needs. As more information is gathered staff should be able to add to individual profiles for all staff to read and become familiar with. This would help residents feel more at home, more comfortable in their environment and feel that people are interested in them as individuals. The registered manager and the deputy manager have left this service since the last inspection. A new manager has been appointed. There has been a turnover of staff and continued use of agency staff. The manager of the service does not have a deputy manager to support her at the moment, and although care assistants have recently been recruited the service still relies on agency to provide nursing staff. This will be discussed further in the staffing and management and administration sections of this report. The staffing situation affects the delivery of care for residents. For example we saw that residents with high care support needs are not receiving care as agreed in their care plans. We saw care plans that show that residents require 1 to 1 support or requires 2 or more people to provide constant supervision and or physical support, or to move resident physically with or without mechanical aids. We spoke with visiting relatives who expressed concern about the lack of staff and the use of agency staff and said that there are different staff on duty when they visit and we dont know the staff who are on duty. We saw information recorded in care plans that shows that residents are well supported by their doctors, district nurses and other health care specialists as required. For example where residents have suffered from a stroke, a speech and language therapist has been involved in their support. We saw that where residents are likely to be at risk, for example of developing pressure sores, falls or falling out of bed, an assessment of risk is completed. Equipment is provided to help prevent or minimise these risks such as a profiling bed with mattress, bed rails and chair cushions. Observations in residents rooms showed that equipment was being used as indicated in their care plans. The duty nurse confirmed that one resident is receiving treatment for a pressure sore that happened while they were in hospital. Daily records are kept for all residents, and where residents are being cared for in bed the records are kept in their rooms. Visiting relatives said this was really helpful as they could see how their relative had been and how their care was being provided. Care Homes for Older People Page 16 of 34 Evidence: A comment was made by visiting relatives about a record of food eaten. The food chart showed that either food was all eaten, refused or part eaten. The daily records say that a resident is eating and drinking safely. A discussion with the manager confirmed that records are kept to monitor food and fluid intake but these records are separate from the care plan and the file kept in the residents bedroom. The manager agreed that it is important to make sure that information is kept up to date in residents bedrooms so that visiting relatives see accurate information. This will help to make sure that anxiety is not caused unnecessarily. The service has a medication policy and procedure that is followed to makes sure the receipt, administration and disposal of medication is safely managed. The agency nurse on duty at the start of the inspection confirmed that only qualified medical staff are allowed to give medication. The manager later confirmed this. Observations were made for two medication rounds throughout the day. Medication Administration Record Sheets (MARS) were checked. We saw that all medication had been signed for and administered as prescribed. Medication is stored safely and correctly in a lockable medical cabinet that is stored in the nurses office. Residents confirmed they were given their medication on time and safely. One resident said they are able to look after their own medication and that the service helps them by checking they are able to carry on doing so. The manager states in the services AQAA that where residents wish to self medicate they are supported and monitored for this. Time was spent talking with residents. They said they were treated with respect and that staff were kind to them. Some residents said they thought the staff were always busy and they have lots to do. Staff were seen to be kind and patient when speaking to residents, and saw to it that residents were not rushed. Staff appeared gentle and keen to make sure residents needs were being met. We observed friendly interaction between staff and visiting relatives. Two residents said they do not wish male carers to give them support, but staff do not always seem aware of this. They still say that A can help you with your bath said one resident. Specific choices should be included in assessments and care plans such as preferred routines and preferred carers as in male or female support to make sure all choices are respected. Care Homes for Older People Page 17 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there have been some improvements to activity planning and oppportunities, not all residents benefit from having access to a range of social and therapeutic activities suited to their needs and their choices. Residents of Cotswold Spa are supported to maintain contact with their families and friends. Relatives and friends are fee to visit at any time. Evidence: At the time the manager completed and submitted the services AQAA to the CSCI an activities coordinator had been employed the service. The coordinator has since left the service and a replacement is being sought. From the information supplied by the manager in the services AQAA we see that the majority of residents are of Christian faith. Residents confirmed they are supported in their faiths, and they are aware of the monthly service visits that take place. Some residents said they attend these services. Previous inspections of the service found that there was not enough stimulation for Care Homes for Older People Page 18 of 34 Evidence: residents living at Cotswold Spa. Since the last inspection there is evidence to show that progress had been made to develop a programme of activities. Unfortunately, since the coordinator left the service, activities have diminished again. This raises a concern that the absence of suitable stimulation may lead to a reduction in mental capacity and therefore does not meet residents needs. It is evident from the activity programme and information established by the previous coordinator, together with the Four Seasons Activity manual that planning and scheduling activities could be reestablished fairly quickly depending on the time taken to recruit another coordinator. The manager remains optimistic and confirmed that interviews are scheduled for week commencing 19th January 2009. We saw evidence to show that since the previous inspection entertainers had been brought in to perform for the residents, such as singers. There was evidence to show that group outings had taken place for those residents wishing to take part, and visits to the local Christmas market had been organised. We saw the activities folder that gave examples of activities residents had taken part in and had shown an interest in. This was discussed with the manager and should be linked with resident profiling to find out about their history, work they used to do and interests they have or had. This will help all staff when talking to residents or offering activities they may be interested in. Although there was evidence to show that some progress in providing activities had been made for residents who are more able, a discussion with the manager focussed on the lack of engagement with residents who are supported in bed. Dedicated time should be established for staff to spend with residents talking or reading to them for example. This will make sure residents are given quality support to make sure they are not isolated. Observations confirmed that staff have very little time to engage with people in this way. Visiting relatives also confirmed that social interaction tended to be provided by visitors for some residents. We met with visitors throughout the day of the inspection and visitors said they were able to come and go as they pleased and there were no restrictions on the number of times or the time of day that they visited. Residents said they have regular visits, one person talked about their weekly trips to the supermarket for their treats. Generally, visitors said they are made very welcome when they visit, although more recently while the service has been short staffed, and with staff being so busy, they havent always been offered a drink. All visitors are required to sign the visitors book that is kept in the entrance to the building. Residents have the use of telephones in their own rooms, and some residents said Care Homes for Older People Page 19 of 34 Evidence: they had their own telephone line installed so it doesnt take up the home line when they are talking with their friends and family. Residents are encouraged to continue with arrangements they may have in place for attending clubs or outings prior to moving to Cotswold Spa. For example, members of the local church regularly take a resident out for trips. The manager recognises in the services AQAA that there seems to be short falls in communication as a result of agency use causing lack of continuity. The manager aims to improve this with a stable staff team and ensure a person centred approach to all residents and visitors providing a point of contact with the use of key workers, this will help to ensure that communication in the home is maintained. We saw evidence where key workers have been introduced and photographs of key workers given to residents. The manager in the services AQAA identifies plans for improvement within the next 12 months to include converting the spa room into a kitchenette and computer room. Tea and coffee making facilities will be available for residents and visitors. Staff told us that residents are able to choose whether to take their meals in the dining room or in their own rooms. We observed residents eating their dinner in the dining room or taking their meals in their own rooms. Some residents said they prefer to stay in their own room I make my room to be like the room I lived in at home, so its like I am still at home said one resident. Generally comments about the food were positive. One resident says they have their own supply of treats and another resident said they order their own meat when they want to and the chef cooks it how I like it. They confirmed they are given a choice and that special diets are catered for such as diabetes and liquidised meals for people who have difficulty with swallowing. Food served looked appetising and appealing. Menus are displayed in the dining room and show options that are available, including a cooked breakfast if residents prefer it. The manager confirmed that records of food eaten and drinks taken are kept in the kitchen. The nurse on duty at the end of each meal checks this information to oversee what food residents have eaten and drinks taken. The record is signed to this effect. The manager was advised that keeping all residents records together does not maintain confidentiality, and that each resident should have their own chart included in their plan of care. Care Homes for Older People Page 20 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has procedures in place to make sure that any complaints or allegations of suspected abuse are taken seriously and are managed appropriately. Evidence: The service has a complaints procedure that explains how complaints can be made and how the Organisation will respond to these. The procedures confirm that all complaints will be responded to within a maximum of 28 days. We saw a copy of the complaints procedure that is made available to everyone, in the main entrance hallway of the building. A log of all complaints is kept. Residents say they know how to complain, and say they would talk to their family if they were worried about anything. Visitors we spoke to confirmed they were aware of the complaints procedure but not everyone had been given a copy. The manager is advised to make sure all residents and relatives have received a copy of the complaints procedure. Information supplied in the services AQAA shows that 4 complaints have been received in the past 12 months. The manager states that all complaints were responded to within 28 days. All 4 complaints were upheld. There has been 1 safeguarding referral made to the Adult Protection Team and 1 safeguarding investigation has taken place. The CSCI has received 1 anonymous complaint since the Care Homes for Older People Page 21 of 34 Evidence: last inspection. This complaint raised concerns about staff levels and the effect this was having on the care being provided. This complaint was referred to the provider to investigate and respond within 28 days. This was completed and the complaint was upheld. Staff spoken to say they would know how to respond should they have any concerns, and they would report any concerns they may have to the nurse on duty or the manager. The nurse on duty at the time of the inspection said she would contact the manager or regional manager in her absence. Residents say generally they are happy at the home. Comments include its a nice home - its alright, but I want to go home and it is good here, but it would be better if we had more staff. Residents confirmed they felt well cared for and that staff help them when they need it. Visitors said they were happy with the care given to their relative. One visitor commented that they were concerned that staff worked hard but didnt always have the time to give the care that some residents needed. The manager supplied information in the AQAA to show that the service had identified that staff would benefit from training to help them respond to complaints and understand procedures. The manager is hoping to see an improvement in communication with the appointment of permanent staff. We saw from a range of information that the service has in place review and evaluation systems to help make sure residents are protected. The manager states in the services AQAA that staff have recently been issued with an up to date manual comprising policys on complaints, bullying, harassment and whistle blowing. The manager said she completes a weekly risk monitoring report that includes monitoring for the protection of vulnerable adults to send to her Regional Manager. In addition, short stay questionnaires are requested from each resident who has moved back home. Staff training records show that staff received training in the Protection of Vulnerable Adults (POVA), and this was completed 6/5/08, 3/11/08 and 6/1/09. Care Homes for Older People Page 22 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents of Cotswold Spa enjoy a comfortable and homely environment. Cotswold Spa is spacious, kept clean and well maintained. Evidence: Cotswold Spa is located in the village of Broadway. The home is in an older building that has been converted for use as a care home. It is on a bus route, and has a garden that can be used by residents, although full access is not possible for residents who are less mobile. Cotswold Spa provides nursing care for older people, who are accommodated on three floors of the building. There are 19 single bedrooms with en suite facilities. Each floor can be accessed by a central passenger lift or by the staircase. There are two communal lounges and a communal dining room. There are various toilet and bathing facilities. Hoists are available to use to help in the care of residents. We looked at parts of the building that included some residents bedrooms. Cotswold Spa is well maintained, attractively furnished and has a pleasant atmosphere. There were no odours noticeable throughout the time the inspection took place. Time was spent talking with residents in their rooms about the service they receive. Care Homes for Older People Page 23 of 34 Evidence: We saw that residents are encouraged to have their own furniture and personal possessions to furnish their rooms and make them more homely. Information supplied in the AQAA showed that decoration has been taking place throughout. New curtains have been fitted. A full time maintenance person is employed to make sure all safety checks are completed and general repairs are done. The manager said that all beds are being replaced with new profiling beds and mattresses, and new chairs are also being supplied. One resident said they had a new chair that is much nicer to sit in. There are plans to refurbish the hairdressing room, and two trees to the front of the building are to be cut back. The communal areas of the building are comfortable and well maintained. There is a rear patio garden with seating where residents can sit in the warmer weather. A number of planted containers decorate the patio area. The service employs dedicated staff to keep the environment clean and welcoming. Time was spent talking to staff working with the laundry. Staff commented on the need to be very particular about looking after residents clothes and the linen they launder. Policies and procedures are in place for managing infection control and staff are provided with disposable gloves and aprons. We saw staff wearing protective clothing for the work they were doing. We saw staff regularly applying alcohol gel to their hands that is now supplied. All cleaning materials are locked in the laundry room. The manager states in the services AQAA that all staff could be more involved with health and safety. The work books are in the process of being completed and staff are yet to complete COSHH and infection control training. The absence of appropriate training may place residents at risk of infection or cross contamination. Staff training in infection control was identified at the last inspection and has not yet been completed. There is a schedule for routine maintenance and upkeep of the buildings and the manager states in the services AQAA that there are plans to convert the spa room into a kitchenette and computer room and the hairdressing room is to receive a make over. Care Homes for Older People Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are available to meet the needs of residents and rigorous staff recruitment procedures make sure that residents are protected. Residents do not always benefit from a consistent and regular staff team. Residents do not always benefit from having their needs met by appropriately trained or qualified staff. Evidence: Residents and visiting relatives commented that they were generally satisfied with the service and the staff. Staff working at the time of the inspection appeared to be enthusiastic and well motivated. The staff complement at the previous inspection included a deputy manager, four qualified nurses and five care staff, cook, laundry person, housekeeper, administrator and a maintenance person. In addition to this an activities coordinator had been employed for 10 hours per week. At the time of the inspection a number of staff had left the service and there had been significant changes to the staffing of the service. A new manager has been appointed, there is no deputy manager in post, and only 2 qualified nurses who work both day and night shifts. Additional cover is provided by a local nursing agency. Concerns have been expressed throughout this report about staffing levels. Residents, Care Homes for Older People Page 25 of 34 Evidence: visiting relatives and staff, have made comments about the lack of staff on duty. Staff commented that residents would benefit if they had more time to spend with them. According to information supplied in the services AQAA there are 2 residents who are bedfast, 13 who need support for all of their personal care, 8 who need supervision with their meals and 11 people who need two or more staff to help with their care. There were 18 residents living at Cotswold Spa at the time the AQAA was completed and 16 during the inspection visit. Care assistant staff levels must be of sufficient numbers and skills to meet the assessed needs of residents at all times. From the copy of the rota supplied at the time of the inspection there are shifts where care assistants working in the service fluctuate from 2, 3 and 4. Five shifts show there were only 2 care assistants working with a qualified nurse. This is potentially unsafe and may put residents and staff at risk and compromise staffs ability to meet everyones needs. Cotswold Spa operates a recruitment policy and procedure where everyone completes an appropriate application form and makes sure that suitable references are obtained including one from most recent employers. Appropriate criminal records and other checks are undertaken before appointments are confirmed. All staff are required to work a probationary period. Records for three members of staff were checked. All required information was seen and confirmation of identity and suitable references was available. The manager confirms that all new staff complete induction training to make sure they can meet the needs of people they support. The service has a staff-training programme based on the training needs for each member of staff. The manager discussed the training plan that shows courses completed during the past year and future courses booked. These include Fire training 9/5/08, manual handling 10/12/08, first aid 29/4/08, POVA 3/11/08 and care planning 27/7/08. Induction training is due to be completed for three recently appointed care assistants. The manager states in the services AQAA that dates are being arranged for staff to complete Food Hygiene and COSHH training. Mandatory training such as Food Hygiene and Infection Control have not yet been completed. Dementia training has not been planned and this was identified as a training need at the last inspection of this service, particularly as staff support residents in their dementia care. The manager states in the services AQAA that all care staff are enrolled onto NVQ 2 provided by the company although staff have not yet completed this. The manager acknowledges that the number of care workers qualified to NVQ standard does not meet the National Minimum Standards. This means that although a qualified nurse is always on duty, residents may not always benefit from having their needs met by appropriately trained staff. Care Homes for Older People Page 26 of 34 Evidence: The manager said that the service is looking to recruit more staff and that their plans for improvement in the next 12 months includes the training and supervision of all staff. Staff said they really like it here and that everybody works well together. Residents said that staff are very kind and helpful. Care Homes for Older People Page 27 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are protected by the services health and safety policies and maintenance checks, and by good financial management. Evidence: An agency nurse was on duty at the beginning of the inspection visit. The manager arrived later that morning to help with the inspection process and to work the afternoon shift. The agency nurse was very helpful and said she has been working regularly at Cotswold Spa. She has become familiar with the residents and the staff and said she enjoys the experience of working here. The manager Emma Benton has been in post a few months and is still familiarising herself with Cotswold Spa, the residents, the staff and Four Seasons as an Organisation. Emma has many years experience working with older people and is a qualified nurse. Emma completes training relevant to her position as the manager of Cotswold Spa such as Health and Safety training 23/7/08. Emma is to make an Care Homes for Older People Page 28 of 34 Evidence: application to the CSCI for consideration to become the registered manager of Cotswold Spa Retirement Residence. An administrator supports the management of the service. The Annual Quality Assurance Assessment (AQAA) was completed and sent to the CSCI prior to the inspection visit. The AQAA is where the manager tells us about the service provided at Cotswold Spa and the ways they plan to improve the service. Information in the AQAA recognises that the service has been through an unsettled period at the beginning of the year with no home manager in post. The plans for improvement section identifies that the new manager needs to be familiar with certain processes of the company and that a remedial action plan is in place that is actioned on a weekly basis. The manager said that she completes a weekly report each week for her regional manager as part of this plan, and this includes monitoring the service, and any complaints or concerns there may be. The regional manager regularly visits Cotswold Spa as one of the ways to monitor the service and how it is being run. Reports are completed and available for inspection. The manager said that recruiting staff is a high priority at the moment, as she also has to work to cover shifts, which means management responsibilities become very stretched and there is less time to move and improve the running of the service. There is a high priority to recruit a deputy manager and activity coordinator to make sure the improvements and development of the service that had been started can continue. Policies and procedures are in place to safeguard residents finances. Secure facilities are in place to keep any monies held on residents behalf safely. Records and receipts of all financial transactions are kept. Health and safety is generally well managed and there are good operational systems in place. Policies and procedures are regularly reviewed and if necessary revised to reflect any changes. On arrival for the inspection we saw that the fire door leading into the kitchen was wedged open, and this was later removed. Additionally, the area by the kitchen door becomes hazardous when the meal trolley is positioned outside the door. This increases the risk of falls and trips to people using the stairway. The service must continue to make sure that all staff adopt safe working practices so that residents are kept safe at all times. Information in the services AQAA confirms that records of monthly checks of the fire safety system and equipment, water temperature and storage, fridge, freezers and Care Homes for Older People Page 29 of 34 Evidence: electrical appliances are completed. The manager said that the maintenance person completes safety checks regularly to promote the health and safety of residents. Care Homes for Older People Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 30 18 1 (a) Care assistant staff levels must be of sufficient numbers and skills to meet the assessed needs of residents at all times. This will make sure that all health, welfare and social care needs can be met for all residents 21/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 It would be good practice to send copies of the complaints procedure to all relatives so the service can be confident that all relatives have received a copy and understand how to make a complaint should they have one. Residents should be consulted about whether they prefer a male or female carer to support them with their personal care needs and any preferences made known should be acknowledged, recorded and respected. The needs of residents with a diagnosis of Alzheimers disease or other types of cognitive impairment should be an integral part of the care plan. Residents should be given the opportunity to participate in Page 32 of 34 2 7 3 7 4 12 Care Homes for Older People a range of therapeutic and social activities suited to their individual needs, preferences and capacities. This will make sure that residents benefit from a stimulating and engaging environment that meets individual needs and expectations, and enhances their sense of well-being. 5 30 The staff training programme should include NVQ in care or equivalent, and specialist dementia care training so that residents can be confident their needs will be met by appropriately trained staff. The service should make sure that all staff adopt safe working practices so that residents are kept safe at all times. This refers to the wedge used to the kitchen door, and the placing of the food trolley outside the kitchen door. 6 38 Care Homes for Older People Page 33 of 34 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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