Inspection on 09/02/08 for Cotswold Spa Retirement Residence

This inspection was carried out on 9th February 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cotswold Spa Retirement Residence 11/01/09

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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Maple Lodge

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Inspirations

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

CARE HOMES FOR OLDER PEOPLE Cotswold Spa Retirement Residence Station Road Broadway Worcestershire WR12 7DE Lead Inspector Jean Thomas Unannounced Inspection 9th February 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cotswold Spa Retirement Residence Address Station Road Broadway Worcestershire WR12 7DE 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) 01386 853523 01386 852403 Cotswold Spa Retirement Hotels Limited (wholly owned subsidiary of Four Seasons Healthcare Ltd) Mrs Rosemary Ann Harris Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20), Physical disability over 65 years of age of places (20) Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate up to 3 service users with a physical disability between the ages of 60 - 65 years. 25th May 2007 Date of last inspection Brief Description of the Service: 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 the less mobile. Cotswold Spa provides nursing care services for older people, who are accommodated on three floors of the home. The home provides 18 single bedrooms and one double occupancy bedroom. Access to each floor is gained via a central passenger lift or via a staircase. There are two communal lounges and a communal dining room. Information regarding the home can be obtained from the Statement of Purpose and the Service Users’ Guide, which are available in the reception area of the home, and copies of the Inspection reports are available on request from the person in charge. Cotswold 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 home is Ms Karen Houghton and the operational director and responsible individual for the registered provider is Pauline Lawrence. The registered manager was Mrs Rosemary Harris but she has recently transferred to another home belonging to the company. At the time of the inspection, the home did not have a registered manager. 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. Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the CSCI is upon outcomes for people and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. This is the second inspection of the inspection year 2007/08. The visit was unannounced and was undertaken for seven and a half hours between 09:00am and 16:30pm. A key inspection addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence, which shows continued safety and positive outcomes for people who use the service. The inspection took place over the course of one day. The deputy manager was present during the inspection and she, along with various members of the staff team, provided assistance during the visit. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, the people who live at the Cotswold Spa Retirement Residence will be referred to as ‘residents’. Documentation maintained in the home was examined including staff files and training records, policies and procedures and records maintaining safe working practices. Two 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. A tour of the building and several bedrooms was made and observations at a mealtime. We read the Annual Quality Assurance Assessment (AQAA), a document required by law on an annual basis from each registered service provider. The AQAA asks providers to give their own assessment of how they are meeting outcomes for people who use their service. Some statistical information is also provided. We looked to see whether residents were being protected and the arrangements for listening to what residents thought about the service being provided at the Cotswold Spa Retirement Residence. Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 6 We observed the interactions between staff and residents around non-personal care tasks, mealtime and the administration of medication were also seen. We looked round the home to see the standard of the accommodation and a number of residents gave permission for their rooms to be seen. We have not needed to visit the home since the last inspection in May 2007. During the inspection a number of residents and their relatives gave their views freely about the home. These comments did not indicate that there were any concerns about the standard of care here and indeed, positive remarks were made about the standard of care and relaxed interactions were observed. We would like to thank staff and residents for their co-operation and hospitality. What the service does well: What has improved since the last inspection? Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 7 The premises are kept in a good state of repair externally and internally. This ensures residents live in a safe environment, which also meets their expectations. Residents are provided with the furniture and equipment identified as necessary to meet their individual needs. This ensures residents receive the care and support they need. Staff members have attended a range of mandatory health and safety training that includes first aid and moving and handling and fire drills/practices carried out at the home. This ensures safe working practices and promotes and maintains the health and safety of residents. What they could do better: We have made 14 recommendations for good practice for the provider to address. Management should take appropriate action to ensure that at all times suitably qualified, competent and experienced people are working at the care home in such numbers as are appropriate for the health and welfare of residents. Staff should have the opportunity to attend training appropriate to the work they are to perform and suitable assistance to obtain appropriate qualifications such as National Vocational Qualifications (NVQ) or equivalent in care. The home’s 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 participate in a range of therapeutic and social activities suited to their individual needs, preferences and capacities. So that residents benefit from spending time in a stimulating and engaging environment, that meets their individual needs and expectations and which enhances a sense of well-being. Residents should be helped to exercise choice and control over their lives. This includes not feeling they have to sit in front of or listen to the television all day when they would prefer to have the opportunity to spend time engaged in other activities. The staff practice of serving the soup, main meal and dessert all at the same time to those residents who choose to have their meals in their room should cease as the food may get cold and be unappetising. This may result in nutritional needs not being met. A record of all the food supplied to residents should be held so that the home can ensure nutritional needs are being met. Menus should be revised to include the vegetables being supplied so that residents are aware of what is being made available to them. Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 8 Details of any complaints investigation should be held so that the home can be sure that any investigation carried out is thorough and appropriate to the issues raised. Records held of any investigation also shows that complaints are taken seriously and are responded to appropriately. Greater effort is required to ensure that all complaints are responded to within 28 days in accordance with the homes complaints policy/ procedure. The home accommodates both male and female residents. As an equal opportunity employer the home also employ both male and female care staff. It is considered good practice to consult residents about whether they prefer a male or female carer to support them with their care needs and any preferences made known should be acknowledged, recorded and respected. The outcome of the home’s annual quality audit of customer satisfaction surveys should where possible be used to bring about any improvements needed in the service. Resident’s meetings should be encouraged and any suggestions or recommendations made by residents considered and where possible used to influence and further improve service delivery. This is so that residents are empowered and have opportunity to influence any changes assessed as necessary in the management of the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Prospective residents and their relatives are provided with information about the home in order to make an informed choice as to whether the home can meet their needs. The preadmission assessment procedures ensure that people choosing to live here have their needs met by experienced staff. The service does not provide intermediate care therefore this standard was not inspected. EVIDENCE: Prospective residents have access to a range of information about the service including a ‘Service User Guide’, so that people know what they can expect and are aware of the services being provided. The ‘Service User Guide’ booklet did not include all the information required by regulation. The regional manager Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 11 informed us that a range of supporting documentation, which included the complaints procedure, and staffing arrangements etc was also issued with the ‘Service User Guide’. Residents and relatives spoken to said they received a range of information about the services provided and were fully informed. Before agreeing admission to the home the service carefully considered the needs assessment of each individual and also considers the capacity of the home to meet the individual’s needs. Admissions to the home only take place if the service is confident that staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident. The residents and relatives who were interviewed indicated residents were well cared for and their care needs were being met. Comments made by them included, “happy with the care provided,” “well cared for” and “I am quite satisfied.” Two visiting family members remarked that the deputy manager had visited their relative and talked to her and the family about her care needs. Residents were observed to be clean, appropriately dressed and well groomed. A sample of two residents’ case records were examined and contained comprehensive assessments including pre-admission assessments carried out by the registered manager. Information from medical staff was included as part of the assessment process and provided a clearer understanding of the needs of the prospective resident. Residents had their weight checked and recorded when they moved into the home so that staff can be alerted to any significant changes. The deputy manager reported that the home also provides respite care but not Intermediate or rehabilitative care. Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that their health and personal care needs will be assessed, well documented, reviewed and met. They will also be supported to access a range of health care services to meet their individual needs. Medication practices are safe and residents can be assured they will be treated with respect by staff. EVIDENCE: The care records belonging to two residents were inspected and showed each had a plan of care, which was regularly reviewed. There was evidence to show the resident had been involved in the development of their care plans. For example, the resident’s wishes in the event of their death had been sought and their wishes recorded. Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 13 There was a care plan for each assessed need which set out in detail the action that needs to be taken by staff to ensure that all aspects of the health, personal and social care needs of the resident are met. Residents interviewed who were able to express a view commented about the standard of care they received. These comments were positive and showed individual needs were being met and staff generally had a flexible approach to the needs of the residents. The plans of care included an assessment of risk for moving and handling. The information was detailed and included the support needed and when the use of a hoist was required. It also identified the type and size of sling to be used. Care plans were in place for continence management and information included the frequency of toileting and the type and size of the continence pad to be used. Records also showed that the care provided was as agreed on the care plan. Daily records detailing the care provided to a resident who was being cared for in bed were held in the resident’s room. A visiting relative remarked that this was very helpful as they could see how their family member had been and what level of care they had received. One entry raised concerns that the resident was developing a cold and in response, the GP was contacted and visited the resident later that day. Family members were reassured by the actions of the staff. Risk assessments for falls, pressure sores and the use of bed rails together with strategies for minimising risks had been prepared. Staff were knowledgeable and were able to demonstrate an understanding of the individuals needs. For example, one resident spoken to commented when I was at home I fell out of bed a few times so Im pleased to have the sides on the bed.” When asked about the need for bedrails the staff member was aware the resident had a history of falling out of bed. Another resident visited in their room did not have bedrails fitted. When asked why bedrails were not required, the staff member remarked that the resident had a diagnosis of Alzheimers disease and although they were at risk of falling out of bed the use of bed rails to prevent this occurring could place the resident at greater risk of harm or injury when getting out of bed. Monitoring records showed that residents being cared for in bed who had bedrails fitted were checked hourly to ensure they were safe. Bumpers to protect residents from harm or injury were fitted to all the bedrails seen. The records belonging to one resident showed they were at high risk of developing pressure sores and that an appropriate pressure area care plan was in place and used to minimize the risk. Observations in the resident’s room showed that equipment assessed as necessary for the prevention of developing Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 14 pressure sores i.e. profiling bed and mattress and a chair cushion was being used. We were informed that one resident was being treated for a pressure sore, which had occurred while they were in hospital. A number of residents were frail and being cared for in bed. The absence of residents requiring treatments for pressure sores indicates they have access to the equipment and care needed to meet their needs. People choosing to move into the home have a primary health care need that requires nursing care. In some instances there are additional needs that result from Alzheimer’s disease or other conditions of dementia. This was noted on one of the care planning records inspected. The care records belonging to a resident with a diagnosis of Alzheimers disease did not include periods of cognitive impairment or any periods of lucidity. Reflecting retained abilities would allow staff to offer care in a consistent manner. The assessment should include what the person is able to do and ensure this is included in the care plan. For example if the person is able to choose what they would like to wear each day this should be encouraged and included in the care plan. Good dementia care includes recognition that people with dementia have the same rights as any other person to make decisions about their lives, but also understands the complex issues around ‘capacity to give consent’. Staff interviewed showed very little understanding of the nature of the diagnosis and its implications for that particular person. Visiting relatives were asked about the standard of care being provided to the person they were visiting. Comments included they are all very kind and caring and they look after her very well, we have no complaints. Daily records were held but the information recorded was not always sufficient to determine whether the care provided was as agreed in the care plan. Detailed records would enable the deputy manager to audit the care provided for residents and would ensure that staff follow the guidance in the care plans. We found evidence of positive outcomes for residents in terms of their health and welfare but it is in the homes interests to be able to show what they have done, along with providing the evidence on which to base the monthly review. Comments made by residents and their relatives showed a consensus of opinion that the home listens to them and responds appropriately. Interactions observed between staff, residents, their relatives and other visitors showed how mindful staff were to responding quickly and efficiently to any enquiries or needs that needed to be addressed. Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 15 The home was able to demonstrate, through individual healthcare records, that residents were in regular contact with General Practitioners and other health care specialists whenever they need to be. For example, care records belonging to one resident showed they had suffered a stroke and were unable to communicate verbally. A Speech and Language Therapist had visited the resident and following assessment advised ‘no intervention’. Staff spoken to said the resident used a range of communication methods and these were understood by the staff, methods used included gestures, posture and eye movements. The home has a good record of compliance with the receipt, administration, safekeeping, and disposal of controlled drugs. Only qualified nurses are permitted to administer medication. Medicines are ordered monthly so that there is not too much kept at the home at any one time. An inspection of the medication administration records did not show any gaps in recording. An inspection of the Medication Administration Record (MAR) charts belonging to the two people whose care was being case tracked showed that medication was being administered as prescribed. Medication is stored safely and securely and in accordance with current guidance. At the time of the inspection there were no controlled drugs being held. The deputy manager informed us that a local pharmacist visited the home regularly to assess medication storage and handling and provide a report on the findings. Residents interviewed, indicated they were treated with respect. Observations throughout the inspection confirmed this occurred. Staff provided support with personal care in private and individuals were made aware of any activity-taking place and were encouraged to participate. For example, supporting individuals to transfer using a sling and mechanical hoist. Both male and female residents are accommodated here and the service employs both male and female care staff. The inspection showed residents are not consulted about whether they prefer a male or female carer to support them with personal care. In addition, any preferences made known by the resident or if appropriate, their representative should be acknowledged, recorded and respected. Respite care is offered although at the time of this inspection there was no one in residence for respite care. Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. Residents do not benefit from having access to a range of social and therapeutic activities suited to their needs and choices are not always supported or encouraged. Relatives are free to visit at any time and do. A varied and nutritious diet ensures nutritional needs are met. EVIDENCE: Information supplied by the home on the Annual Quality Assurance Assessment (AQAA) document showed that none of the residents were from minority ethnic communities, social or cultural groups with any specific needs or preferences. A number of residents belong to different Christian faiths and most residents spoken to were aware of a monthly religious service taking place at the home, and were invited to attend. Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 17 An inspection of the service carried out on February 7th 2006 showed that the home did not provide sufficient opportunities for stimulation through leisure and recreational activities in and outside of the home, which suit the needs, preferences and capacities of residents. The next and most recent inspection was carried out on May 22nd 2007 showed there had been no action taken to bring about the improvements needed in the provision of individual and group activities. Residents should find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. Particular consideration should be given to residents with a diagnosis of dementia and other neurological impairments so that they also have access to opportunities and are encouraged to participate in daily life activities. The absence of appropriate stimulation may lead to a reduction in mental capacity and therefore not be in the person’s best interests. During the key inspection on May 22nd 2007 we were told ‘a carer was to go on a course for activities and stimulation’ and a ‘masseur’ visited the service and carried out hand massages. Residents spoken to who at the time of the inspection were able to express a view reported they were not aware of any activities and had not been offered a ‘hand massage’. Other comments included, I wish there was more to do and we spend all day in front of the television whether we like it or not everyday is the same there’s nothing to do and. “ Why do we have to have the television on all the time? One resident’s care plan identified the need for ‘staff to play old songs in the lounge’ and to make sure the resident ‘joins in other activities.’ We found no evidence to suggest the resident has the opportunity to listen to music of their choice or of their participation in any other activities/outings etc. This showed that the resident’s needs were not being met. Observations showed that staff were busy and had very little time to engage in meaningful conversation with residents especially those being cared for in bed who were to a great extent dependent on visitors to provide social interaction and stimulation. Information supplied on the AQAA document received by us in October 2007 included plans by the home to introduce three monthly meetings for relatives, residents and their friends. At the time of the inspection this had not been introduced. The deputy manager was aware of the improvements needed. Information supplied in the AQAA also acknowledged the shortfalls. Residents continue to be denied suitable opportunities for stimulation through leisure and recreational activities. This showed a lack of commitment by the management to bring about the improvements needed to enhance the quality Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 18 of life for residents. We therefore concluded that outcomes for residents were poor and the service falls below the standard expected. On speaking to residents, it was clear that visiting is positively encouraged with no restrictions imposed. Residents and their relatives confirmed that visitors are made very welcome at the home. Comments also indicate that the staff are very clearly committed to respecting the privacy and dignity of residents, which is acknowledged with marked praise from residents and their relatives. There is a visitor’s book all must sign upon entering and leaving the home. Residents were able to receive their visitors in private if they wish. We were told residents could have their meals where they choose and could have extra portions if they desired. Residents praised the food. Comments include “ we always have a choice” and “the food is good.” We found that residents requiring specialist diets such as diabetic and liquidised foods were catered for. Fresh vegetables were seen in the food store and fresh fruit available in the dining room. Observations at a mealtime showed six residents had lunch in the dining room and the remaining residents had their meal in their room. The staff practice of serving the soup, main course and dessert all at the same time to residents in their rooms may mean the food is cold and therefore less tasty. Residents should have the opportunity to finish each course before the next is served. Food being supplied looked attractive and appetizing. Meals taken to residents in their rooms were not covered and therefore the risk of food contamination increased. Food being transported around the home should be covered to reduce the risk. The kitchen was clean and appeared well equipped. Food requiring low storage temperature was stored in the fridge and was covered and dated. This helps reduce the risk of contamination and ensures food is fresh when consumed. The menus were displayed in the dining room. Comments from residents and observation of a mealtime showed residents are provided with a wholesome and nutritious diet. Residents remarked they were offered alternatives and could have a cooked breakfast if they chose. A record of food supplied by the home at breakfast confirmed this occurred. Menus should be revised to include vegetables. This will ensure residents are aware of alternatives and provide an accurate record of the food being provided. At lunchtime on the day of the inspection, residents were offered asparagus soup and pork and apple casserole or turkey escalope (served with potatoes, cabbage and cauliflower), followed by rice pudding. Records inspected showed the nutritional intake and well being of residents is regularly monitored and adjustments are made to individual menu Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 19 requirements whenever this is necessary. For example if a resident didnt like what was on the menu an alternative would be offered. Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures in the home ensure that any complaints or allegations of suspected abuse are taken seriously and are managed appropriately. EVIDENCE: The home has a complaints procedure which specifies how complaints may be made and who will deal with them, with an insurance that they will be responded to within a maximum of 28 days. A copy of the complaint’s procedure was displayed in the reception area of the home. Residents spoken to who were able to express a view were aware of the procedure for raising any concerns. Most residents said they would talk to the deputy manager or a nurse if they were unhappy or dissatisfied with any aspect of the service. Two residents said they would talk to their family. Information supplied on the AQAA showed the number of complaints received within a 12-month period was four and the percentage of complaints resolved within 28 days was 75 . This was below the minimum standard, which requires complaints to be responded to within 28 days of receipt. Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 21 Records of complaints were held and the information recorded included the date the complaint was received, name of the complainant, details of the complaint/concern and the outcome. Since the last inspection records showed there had been one complaint received about the service on July 2nd 2007 and this was responded to on July 3rd 2007. The complaint was about ‘poor standard of care and staffing at 7am. The complaint was upheld and resulted in additional staff being on duty in the mornings. Details of any investigation were not held therefore we were unable to identify what the gaps in service provision were or the impact this may have had on residents. Accurate recording shows whether complaints are taken seriously investigated thoroughly and whether they are responded to appropriately. The outcome of any complaints investigation should be considered in the quality assurance assessment of the service and where possible used to enhance the quality of the service. Since the last key inspection we have received one complaint, which raised concerns about the management arrangements following the recent departure of the registered manager. The deputy manager had been given additional responsibility and it was alleged that the owners and some of the nurses had placed considerable pressure on the deputy manager. The complaint was looked at as part of the inspection of the service and the outcome is included in the Management and Administration outcome group of the report. During this period there has also been an allegation of abuse and a staff member suspended pending the outcome of a full investigation involving external health and social care agencies. Following the investigation the multi agency team concluded there was insufficient evidence to reach a conclusion regarding the validity of the allegation. The staff member resigned and their name sent for inclusion on the Protection of Vulnerable Adult register. This was in accordance with the arrangements for the Protection of Vulnerable Adults. The residents who expressed their views remarked they had no complaints about how they were being cared for and neither had any of the relatives who were interviewed. Comments noted include “ there’s nothing to complain about here” and “I would like to live here, its lovely.” Staff interviewed demonstrated an awareness of the procedure to be followed when responding to allegations of possible abuse. Staff remarked that they had never had cause to be concerned about the care and support given to residents. Staff training records showed that not all staff had attended adult protection training. Appropriate training is necessary so that the home can be confident that staff understand how to protect vulnerable people from abuse and can respond to any suspicion or allegation of possible abuse appropriately. Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 22 Residents who were interviewed indicated that they had been well treated by staff. Comments noted include staff gentle”, “ dont rush me and all very nice to me.” Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from a comfortable, clean and well maintained environment that has the facilities to meet their needs. EVIDENCE: The home provides a physical environment that is appropriate to the specific needs of the people who live there. The well-maintained environment provides specialist equipment and adaptations to meet their needs. The home is a very pleasant and safe place to live. The home has a range of toilet and bathing facilities, as well as each bedroom having an ensuite lavatory. Hoists, and any other equipment that is required to assist in the care of the residents are also provided in adequate numbers. Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 24 The premises were inspected and found to be clean and well furnished. The rooms of some of the residents were seen, with their permission, and each was personalised to the extent that the individual wishes. Telephones were available in each of the bedrooms visited. The quality of the furnishings and fittings in residents’ rooms was good. All of the rooms visited were personalised with photographs and ornaments making the rooms feel warm and homely. A number of residents were being cared for in bed and observations in their rooms showed residents had safe and easy access to a call alarm. The deputy manager informed us that since the last inspection the one double room had now been converted to single occupancy. This further ensures residents privacy and dignity is upheld. The key inspection visit to the service on May 25th 2007 showed the premises both internally and externally were not kept in a good state and furniture and equipment identified as necessary to meet a resident’s needs was not supplied in a timely manner. The inspection showed the two shortfalls identified had been addressed as the home was now found to be in a good state of repair both internally and externally and any furniture and equipment assessed as necessary to meet residents needs had been supplied. For example one resident told us she was unable to sit comfortably or safely in her chair consequently the home supplied a new chair, which she found very comfortable and was no longer at risk of falling out of the chair. Information supplied on the AQAA showed many areas of the home including bedrooms had been redecorated and had new carpets fitted. A further nine profiling beds and mattresses had been purchased and used by those residents assessed as being at risk of developing pressure sores. The communal areas of the home were comfortable and well maintained and provide a pleasant environment for all who live here. Inspection outside the home showed that a patio area provided a pleasant area for residents choosing to sit outdoors. We were informed that remedial work to repair a supporting wall in the garden had been completed. Observations outside showed raised paving stones and a number of plant containers on the patio. We talked to the deputy manager about the need to ensure residents were not placed at risk of tripping when walking on the patio. The deputy manager demonstrated a commitment to ensuring a risk assessment was carried out and any action identified as necessary undertaken so that residents can be confident they will not be at risk should they choose to spend time outside. The home has dedicated ancillary staff who keep the home very clean and free of unpleasant odours. Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 25 As this is a home that provides nursing care there are strict protocols in place to ensure that the prevention of cross contamination and infection control are well managed. Staff were observed to wear disposable gloves and aprons when carrying out personal care tasks and regularly washed their hands. Information in the AQAA showed there is a policy for preventing infection and managing infection control but only two staff had attended appropriate training. The absence of appropriate training may place residents at risk of infection or cross contamination. Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Sufficient staff are available to meet the needs of residents and rigorous staff recruitment procedures ensure the protection of residents. Residents do not always benefit from having their needs met by appropriately trained all qualified staff. EVIDENCE: The staff complement includes a deputy manager, four qualified nurses, five care staff, cook, laundry person, housekeeper, administrator and a maintenance person. Agency staff are generally used to provide cover for any gaps in the staff roster. Four week’s staff rosters were seen and showed nurses and carers worked a 12-hour shift from 8am - 8pm or 8pm - 8am. A qualified nurse was always on duty and was supported during the day and evening by four carers and by one carer at night. At the time of the inspection, a cook supplied by an employment agency was preparing the meals. We were informed that the agency cook regularly provided cover in the absence of the home’s cook and was familiar with the daily routines and the dietary needs of residents. Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 27 Inspection of the staff roster showed that the name of the agency cook and the number of hours worked was not included. It is important to keep a record of who is working in the home their role and the number of hours worked so that management can be confident sufficient numbers of experienced staff are available to meet the needs of the residents. The deputy manager demonstrated a commitment to ensuring the staff roster includes all the information required. Information supplied on the AQAA showed that since the last inspection additional ancillary staff had been employed to undertake laundry and domestic tasks seven days a week. Staff interviewed said there were usually sufficient numbers of staff available and confirmed that agency staff were used to cover any shortfalls. We were told that the majority of agency staff had been working at the home for a number of months and were familiar with the individual needs of residents. Staff remarked that residents would benefit if the staff had more time to spend with them. There was a consensus that an additional staff member was required at suppertime as one of the carers had to spend time in the kitchen preparing food and carrying out domestic tasks. The deputy manager had identified the shortfall and was actively trying to employ someone to work in the kitchen so that care staff would be available to meet the needs of residents. The deputy manager also remarked that an interview for a carer was due to take place later that day. Comments from residents include “I can usually get someone when I need them, they are always very busy” and “they are kind and come when I ask them.” Information supplied on the AQAA document was not completed for the National Minimum Standards outcome area: staffing. For example the number of staff hours used were not recorded and no entry made under the headings ‘what we do well’ and ‘ what we could do better’ The laundry was inspected and was well managed. Bed linen, which had been laundered, was noted to be clean. Residents remarked they collect my clothes every day and they bring them back the next day and my clothes are taken away every day for washing and come back the next day and I have no complaints I think they do a good job. Residents spoken to said they were satisfied with the standard of the accommodation. A number of visiting relatives spoken to also remarked on the quality of the laundry service and of the high standard of cleanliness in the home. The home has previously been seen to carry out checks to make sure the people who work here are safe to work with the residents. Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 28 These checks include asking the police if a new member of staff has ever been found guilty of a crime, and asking people who used to employ them if their work was good and if they are the right sort of person to work with and care for the residents. Inspection of the staff records belonging to two recently employed staff members confirmed rigorous staff recruitment practices continued to be followed. The staff on duty were interviewed on a range of topics associated with their work (such as fire procedures, adult protection procedures, staffing arrangements). They were found to be generally knowledgeable about their roles and responsibilities. Staff said they had access to training and gave examples of their achievements while employed at the home. For a relatively new worker this included an induction, which involved ‘caring for residents’ and ‘having an understanding of their conditions’. Staff were aware of the need to respect and value the people in their care. The home keep records that say what training courses staff have attended, and when they did them. We were informed the records were used to identify any gaps in learning. Records held showed that since the last inspection 15 staff had been trained in moving and handling, four in fire training/prevention, two health and safety and nine staff were now trained in first aid. One staff member interviewed said they had also “been trained on how to empty urinary catheter bags safely.” We were informed that only 20 of the carers employed by the home have obtained a National Vocational Qualification (NVQ) in care. Therefore the number of care workers qualified to NVQ standard or equivalent falls below the National Minimum Standard that a minimum ratio of 50 trained care staff is achieved by 2005. We do not know how many agency staff working at the home were qualified. This means that although a qualified nurse was always on duty residents may not always benefit from having their needs met by appropriately trained staff. Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 29 Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 30 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are protected by the home’s health and safety policies and maintenance checks and by good financial management. EVIDENCE: We were informed the registered manager had been transferred to another care home belonging to the company and the home was currently without a registered manager. As an interim arrangement and pending the appointment of the suitable person to manage the care home the deputy manager (supported by the regional Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 31 manager) had accepted this responsibility. The deputy manager remarked that in her absence nurses had been supported to make decisions and felt more able to take full responsibility for any decision-making and did not always feel the need to contact the deputy manager when she was not at the home. The AQAA gives us some limited detail about the areas where they still need to improve. More supporting evidence would have been useful to illustrate what the service has done in the last year or how it is planning to improve. The areas they are planning to achieve this are briefly explained. The data section of the AQAA was completed but a significant number of other areas have been left blank. There was a lack of understanding of the purpose of the AQAA. For example information supplied showed that annual customer surveys were used to obtain the views of people who use the service but the information supplied did not include what/if any changes had been made or are planned as a result of listening to people who use the services. Under the heading ‘Health and Personal Care the home was asked to identify what they could do better. The response was to involve residents more in decision-making of their care particularly end of life care.” We expect the home to identify areas needing improvement and also to consider and include how these improvements were to be managed and implemented. Under the heading ‘Management and Administration’ there were no entries to show what the home do well or what they could do better. The home has a quality assurance strategy that includes gathering information and feedback from residents via a customer survey about the quality of the service. We were told that the annual customer survey was now due as the most recent survey had taken place about 12 months ago. The regional manager supplied information about the outcome of the 2007 quality audit, which showed 84 of those surveyed thought the service was either good or very good. The regional manager monitors the service and makes unannounced monthly visits and reports on the conduct of the home. This is so that the home’s owners can be sure residents are being properly cared for and the home is being well managed. Copies of the reports were held and open to inspection. Policies and procedures were in place to safeguard residents’ finances. For example, monies belonging to five residents were being held by the home. Secure facilities were in place for safekeeping monies held on their behalf. Records and receipts of all financial transactions were held. We obtain information on the AQAA before inspections. This information includes confirmation that all necessary policies and procedures are in place and are up-to-date. These are not inspected on the day but the information is used to help form a judgment as to whether the home has the correct policies to keep residents’ safe. Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 32 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. Observation showed that the fire door leading into the kitchen was wedged open. This issue was brought to the attention of the deputy manager who responded immediately by removing the door wedge, closing the door and informing staff of the potential risks to residents. The deputy manager demonstrated a commitment to promoting safe working practices. We will look at this again during the next inspection so that the home can be sure staff continue to adopt safe working practices and residents safety assured. Although the kitchen has an extractor fan the ventilation was considered poor as condensation could be seen on the walls and the room was reported to be hot. The external door could not be left open as fly screens necessary for preventing flies other insects or rodents from entering the kitchen were not fitted. The fire records held details of when fire drills, fire training and weekly fire alarm checks were carried out. Fire exits were kept clear and the home had a fire risk assessment. This promotes the health and safety of residents. Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 33 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 1 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP7 OP7 Good Practice Recommendations The needs of residents with a diagnosis of Alzheimer’s disease or other types of cognitive impairment should be an integral element of the care plan. Daily records should always show whether the care being provided is as agreed in the care plan. Detailed daily records would enable the manager to audit the care and support being provided for residents and would ensure that staff follow the guidance in the care plans. Residents should be given the opportunity to participate in a range of therapeutic and social activities suited to their individual needs, preferences and capacities. So that residents benefit from a stimulating and engaging environment that meets individual needs and expectations and enhances a sense of well-being. Greater effort Is required to ensure residents are helped to DS0000018644.V359615.R01.S.doc Version 5.2 Page 35 3. OP12 4. OP14 Cotswold Spa Retirement Residence 5. OP15 exercise choice and control over their lives. This includes not feeling they have to sit in front of or listen to a television all day when they would prefer to have the opportunity to spend time engaged in other activities. Residents who choose to have their meals in their rooms should not have the soup, main meal and dessert served at the same time as food may go cold and not be enjoyed. This may result in nutritional needs not being met. To reduce the risk of possible contamination and to promote health and safety food being transported around the home should be covered. To reduce the risk of contamination food transported to resident’s rooms should be covered. A record of all the food being provided to residents should be held so that the home can be sure nutritional needs are being met. Menus should be revised to include vegetables so that residents are aware of what is being made available to them. Details of any investigation carried out in response to complaints should be held so that the home can be sure any investigation carried out is thorough and appropriate to the issues raised. Records held of any investigation also support the view that complaints are taken seriously and are responded to appropriately. Greater effort is required to ensure that all complaints are responded to within 28 days in accordance with the homes complaints policy/ procedure. All staff should attend training on safeguarding so that the home can be sure residents are protected from abuse. Additional staff should be made available to meet the needs of residents at ‘suppertime’. 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 staff training programme should be revised to include National Vocational Qualifications (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. Feedback on annual surveys should where possible be used to improve the service. DS0000018644.V359615.R01.S.doc Version 5.2 Page 36 6. 7. OP15 OP15 8. OP16 9. 10. 11. OP18 OP27 OP27 12. OP30 13. OP33 Cotswold Spa Retirement Residence 14. OP38 Resident’s meetings should be actively encouraged and any suggestions or recommendations made at these meetings should be used to influence the service. This can empower residents and influence the management of the home. Consideration should be given to having fly screens fitted to the external door of the kitchen so that the door could be left open to increase ventilation and reduce the risk of staff wedging the fire door open when the kitchen gets too hot. This would ensure the continued safety of residents by reducing the risk of fire. Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cotswold Spa Retirement Residence DS0000018644.V359615.R01.S.doc Version 5.2 Page 38 - 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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