Inspection on 31/10/06 for Cottage Christian Nursing & Residential Home

This inspection was carried out on 31st October 2006.

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

The inspector 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

Cottage Christian Nursing &... 01/11/05

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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 Cottage Christian Nursing & Residential Home Granville Road Newport Shropshire TF10 7EQ Lead Inspector Joy Hoelzel Key Unannounced Inspection 31st October 2006 11:00 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 Cottage Christian Nursing & Residential Home DS0000065121.V297434.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. Cottage Christian Nursing & Residential Home DS0000065121.V297434.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cottage Christian Nursing & Residential Home Address Granville Road Newport Shropshire TF10 7EQ 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) 01952 825557 01952 820883 thecottage@schelathcare.co.uk www.southerncrosshealthcare.co.uk Southern Cross Care Homes No 2 Limited Mrs Beverley Harvey-Howson Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (29), Physical disability (6), Terminally ill (5) of places Cottage Christian Nursing & Residential Home DS0000065121.V297434.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home may accommodate a maximum of 6 persons with a Physical Disability. The home may accommodate a maximum of 5 persons who are Terminally ill. Staffing levels in the home must meet the minimum levels required throughout the 24 hr day, including weekends, for service users who have low to medium nursing needs. Additional staff must be on duty when high dependency service users are accommodated. These minimum levels are for direct nursing and personal care only. They do not include ancillary staff. 07:30-14:00 08:00 30-34 clients Assistants 34-39 clients Assistants 40 clients Assistants Date of last inspection 1st November 2005 2 RN`s 6 Care Assistants 2 RN`s 2 RN`s 5 or 6 Care Assistants 2 Care 2 RN`s 6 Care Assistants 2 RN`s 5 Care Assistants 1 RN 3 Care 2 RN`s 5 Care Assistants 2 RN`s 4 Care Assistants 1 RN 2 Care 14:00-20:30 20:00- Brief Description of the Service: Cottage Christian is a purpose built Care Home registered to provide both personal and nursing care for up to a maximum of 40 Older People. This may include people with a physical disability and people with terminal illness. The Home is owned by Southern Cross Healthcare and is situated near the centre of the small Shropshire Town of Newport. Shops are to be found nearby and a modern Health Clinic is immediately adjacent. All bedrooms are fully furnished and have en suite facilities. The communal areas are homely and comfortable. The gardens are well maintained and easily Cottage Christian Nursing & Residential Home DS0000065121.V297434.R01.S.doc Version 5.2 Page 5 accessible. Current weekly fees range from £460.76 - £750.00. Information of the home and the provision of the service are available in the statement of purpose and service user guide, both documents have recently been revised and are readily available. Commission for Social Care Inspection Reports for this service are available from the provider or can be obtained from www.csci.org.uk Cottage Christian Nursing & Residential Home DS0000065121.V297434.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced key inspection is the first of the statutory inspections for 2006/07 and took place over four hours on Tuesday 31st October 2006. It was conducted by one regulation inspector. Twenty three of the thirty eight National Minimum Standards for older people were inspected on this occasion. Forty people are currently living at the home, staffing numbers were observed to be at satisfactory levels. Three case files were selected for case tracking, relevant documents and procedures were inspected, together with a selection of staff personnel files. A full tour of the premises was conducted. What the service does well: What has improved since the last inspection? What they could do better: No requirements have been made following this inspection. Cottage Christian Nursing & Residential Home DS0000065121.V297434.R01.S.doc Version 5.2 Page 7 Through discussions with residents, visitors, staff and the manager, direct observation of working practices and records it is evident that the home is successfully providing a high standard of care to the people living at 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. Cottage Christian Nursing & Residential Home DS0000065121.V297434.R01.S.doc Version 5.2 Page 8 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 Cottage Christian Nursing & Residential Home DS0000065121.V297434.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 1,3,6 Quality in this area is excellent. This judgement has been made using available evidence including a visit to this service. Significant time and effort is spent making admissions to the home personal and well managed. Prospective residents and their families are treated with dignity, respect and understanding for the life changing decisions they need to make. EVIDENCE: The home has a statement of purpose and service user guide detailing all aspects of the care provision. Both documents are readily available to current and prospective residents and other interested parties. The case file of the person most recently admitted to the home was inspected and included an assessment carried out by a senior staff member prior to the person moving into the home. Other pre admission information was available from the local primary care trust. An initial plan of care is generated at the point of admission based on these assessments. Whenever possible the person on/or representative is involved fully in the care planning process. A family member confirmed that a visit was Cottage Christian Nursing & Residential Home DS0000065121.V297434.R01.S.doc Version 5.2 Page 10 made to the home prior to making the decision to move in and another relative had been fully involved with the resident in the care planning process. The home does not offer an intermediate care service. Cottage Christian Nursing & Residential Home DS0000065121.V297434.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 7,8,9,10 Quality in this area is excellent. This judgement has been made using available evidence including a visit to this service. The care plan is used as a working tool and is understood by staff. It is written in clear language and can be used in an emergency by people who are not familiar with its content. Each care plan includes a comprehensive risk assessment. Management of risk takes into account the needs of residents balanced with their aspirations for independence and choice. EVIDENCE: Three case files were selected for inspection, each contained full and concise details on the assessed needs of the individual. All relevant risk assessments had been carried out and linked into a specific plan of care. The plans are reviewed at monthly intervals or when a change has been identified, the resident and/or relative being fully involved in the process. Full details of pressure area care and prevention of pressure ulcers are recorded and referenced with a body mapping record. One case file detailed a risk assessment for a person with cognitive difficulties and for sometimes leaving the premises alone. A missing persons policy is included in the file together with instructions for staff to reduce the risk of this Cottage Christian Nursing & Residential Home DS0000065121.V297434.R01.S.doc Version 5.2 Page 12 person getting ‘lost’. A meeting was arranged to discuss the difficulties with the family with the action needed to reduce the risk agreed. A record is made of visits to and from specialist healthcare professionals and includes the speech and language therapist, community mental health nurses, dietician, GP’s etc. The home operates a twenty eight day regimen for the administration of medication using a monitored dose system with the additional use of bottles and boxes. The current medication is divided into three trolleys and stored the treatment rooms on the ground and first floors. Surplus medication is kept to a minimum. Recordings in the controlled drugs register and the actual amount of drugs stored in the controlled drugs cabinet accurately corresponded. The Medication Administration Record appeared to be completed at the time of the administration of the medications, no gaps on the record was seen. The nurse demonstrated good knowledge of the safety and procedures for the administration of medications. The care staff were observed to be assisting residents with personal care discreetly and in a manner which promotes a persons dignity. Staff, residents and visitors were observed to be interacting well with lots of chatter and conversation occurring. Three people spoke very highly and were complimentary of the staff at all levels. Cottage Christian Nursing & Residential Home DS0000065121.V297434.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 12,13,14,15 Quality in this area is good. This judgement has been made using available evidence including a visit to this service. The routines of the home are planned around the residents’ needs and wishes. Staff listen to residents and make considerable effort to provide a flexible service, which enables them to enjoy a better quality of life. EVIDENCE: Two staff members on a daily basis arrange social and recreational activities. The activities person stated that during the afternoon, residents would be offered the opportunity for assisting with the preparation of the firework party arranged for later on in the week. During the morning some residents were in the lounge listening and singing along to songs and music. All appeared to be enjoying this activity. One person stated that during the afternoon she would prefer to sit in the quiet lounge where she is able to watch the TV and chat to other ladies and gentlemen. Religious services and Holy Communion are arranged regularly throughout the week for anyone wishing to partake. The statement of purpose contains information with assisting with the upholding of spiritual needs. The activities programme is displayed on the notice board at the entrance to the home. Cottage Christian Nursing & Residential Home DS0000065121.V297434.R01.S.doc Version 5.2 Page 14 People visiting the home during the inspection confirmed that they are able to visit at times suitable to their relative and friend and that they always felt welcome to visit. During the tour of the premises many of the bedrooms were highly individualised with personal possessions. Staff were observed to be offering residents choices and preferences as to the activities of the day in an appropriate way, very much dependent on the capabilities and capacity of each individual. A four weekly rotational menu is operational and offers a good choice of meals on a daily basis. Records are maintained of the food offered to and taken by each individual. The dining room on the ground floor was attractively prepared in advance of the lunchtime meal; the meal was served from a heated trolley in the dining room. Staff were observed to be assisting some people with their meal in discreet and appropriate manner. Residents have the choice of where they wish to eat; one lady confirmed that she likes to go to the dining room for breakfast and lunch and stated ‘the food is good, I like it, no problems’. The manager stated that the Environmental Health Officer had recently inspected the kitchen with the recommendations made following the visit being actioned. A staff meeting was arranged with a revision of staff working practice to ensure the recommendations will be met. Cottage Christian Nursing & Residential Home DS0000065121.V297434.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 16,18 Quality in this area is excellent. This judgement has been made using available evidence including a visit to this service. The service has a clear complaints procedure that highlights the importance of complaining or making suggestions for improvement and is very clear when an incident needs external input, and is open in discussing incidents with external bodies (CSCI, local adult protection). EVIDENCE: The statement of purpose and service user guide contains information of the home procedures for dealing with concerns and complaints. A copy of the procedure is displayed at the entrance of the home. A complaint log is maintained for the auditing of complaints, the manager stating that no formal complaints have been received and that if any one had any concerns staff would attempt to expediently find a satisfactory solution. The manager informed of a recent referral she had made to the vulnerable adults multidisciplinary team following an incident relating to a person receiving day care at the home. The investigation is currently ongoing. Policies and procedures in the protection of vulnerable adults are readily available for staff reference if required. All staff have received training in adult abuse awareness in the past twelve months. Cottage Christian Nursing & Residential Home DS0000065121.V297434.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 19,26 Quality in this area is good. This judgement has been made using available evidence including a visit to this service. The home continues to provide a high quality, comfortable and safe environment for those in residence. EVIDENCE: The Cottage is a purpose built home and is fully suitable for the current resident group. The private and communal areas are well furnished and maintained, warm and homely in character. One person and relative stated that the accommodation is ‘very comfortable’ and although the person had not been resident for very long went on to say that although ‘its very early days…. feel very settled’. The fire officer visited the premises in November 2005 no recommendations were made following the inspection. At the time of the inspection all areas of the home were clean and hygienic. Good systems of control are in place for the prevention of cross infections. Cottage Christian Nursing & Residential Home DS0000065121.V297434.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 27,28,29,30 Quality in this area is good. This judgement has been made using available evidence including a visit to this service. The service has a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice, recognition of the importance of effective recruitment procedures in the delivery of good quality services and for the protection of residents. EVIDENCE: Staffing levels are maintained in line with the staffing notice as detailed on the conditions of the registration of the home. The manager is supported with first level nurses and a team of care and ancillary staff. A rota is maintained to show which staff are on duty at any given time of the day or night. The manager stated at present there are no staff vacancies. Two staff personnel files were selected for inspection and contain all documents relating to a robust recruitment procedure. Certificates and records of achievement are retained to evidence the training undertaken by each individual. Each staff member has regular supervision with their line manager and an annual appraisal of their work performance. Training and development needs are identified and arranged throughout the year. Statistics are maintained of the numbers of staff undergoing core topics and specialist area training. All care staff are encouraged to gain accreditation for National Vocational Qualification Level 2 and 3 in care. Cottage Christian Nursing & Residential Home DS0000065121.V297434.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 31,33,35,38 Quality in this area is good. This judgement has been made using available evidence including a visit to this service. There are very clear lines of accountability within both the external and internal management structures and the management approach creates an open and positive atmosphere from which the service users benefit. EVIDENCE: The registered manager is a first level nurse with the knowledge and experience to successfully manage the home on a day-to-day basis. Through out the duration of the inspection the manager demonstrated a sound knowledge of the current resident group and the difficulties and dilemmas encountered with the ageing process. Training for accreditation on the Registered Managers Award is ongoing. There are very clear lines of accountability both within the home and with the external management structure. Cottage Christian Nursing & Residential Home DS0000065121.V297434.R01.S.doc Version 5.2 Page 19 Quality assurance and monitoring systems continue with weekly and monthly audits conducted. Satisfaction surveys are sent to residents, families, visiting professionals and all grades and levels of staff and are used as a monitoring tool. Staff and residents meeting are arranged on a regular basis with minutes kept of the content of the meeting. Procedures are in place for the safekeeping of residents’ monies should they so wish. Two staff members have been nominated as dedicated key holders to the safe. Reconciliation and audits of the transactions are carried out each month to ensure the accuracy of the record and the amount of cash held. The administrator commented that spot checks are also carried out periodically. Records are maintained, and evidence that the required health and safety checks are being carried out at regular intervals in relation to fire safety, hot water temperatures, portable appliance testing and chemical substances (COSHH). Cottage Christian Nursing & Residential Home DS0000065121.V297434.R01.S.doc Version 5.2 Page 20 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 4 X 4 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 3 Cottage Christian Nursing & Residential Home DS0000065121.V297434.R01.S.doc Version 5.2 Page 21 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. Refer to Standard Good Practice Recommendations Cottage Christian Nursing & Residential Home DS0000065121.V297434.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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