CARE HOMES FOR OLDER PEOPLE
Cottingley Hall Bradford Road Bingley West Yorkshire BD16 1TX Lead Inspector
Gillian Sangster Unannounced 12 July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cottingley Hall J52 S19866 Cottingley Hall V226814 260505 Stage 2.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service CottingleyHall Address Bradford Road Bingley BD16 1TX Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01274 592885 01274 532563 Bupa Mrs S Sowden Care home with nursing 51 Category(ies) of Physical disability (51) Old age (51) registration, with number of places Cottingley Hall J52 S19866 Cottingley Hall V226814 260505 Stage 2.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: That Susan Sowden completes the NVQ level 4 in Care within a timescale of 18 months from September 2005 That Susan Sowden complete units RM1 and RM2 of the Registered Manager`s Award within a timescale of 2 years from September 2005 Date of last inspection 3/11/04 Brief Description of the Service: Cottingley Hall is a converted property situated between Saltaire and Bingley. The home is regsitered to provide nursing care for older people aged over 65 years and people who have a physical disability. Accommodation is provided in thirty single rooms and five doubles, all but one have en suite facilities. There are three lounges and two dining rooms. There are extensive gardens and pation areas which are accessible to residents. Cottingley Hall J52 S19866 Cottingley Hall V226814 260505 Stage 2.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. I carried out this unannounced inspection between 9.15am and 4.30pm. The registered manager was not present and I was assisted by the nurse-incharge. A manager from another BUPA home was present for the feedback at the end of the visit. I spoke with eleven residents and three relatives. I also spoke with four staff as well as the nurse-in-charge. I looked at records including care plans, staff recruitment files, accident reports, complaint records, maintenance reports and duty rotas. The home is registered for 51 places but currently only 40 places are available. All requirements from the last inspection have been met. Requirements and recommendations from this visit are detailed at the end of the report. What the service does well:
The home provides a high standard of “hotel” style accommodation with good quality furnishings and fittings. It is well maintained and spotlessly clean. There are extensive well maintained gardens that are accessible to the residents. Several residents commented on how much they liked their rooms and the views onto the gardens. Residents said that they enjoyed the meals describing the food as “excellent” and “very good”. There is a good choice of foods and residents said “we can have what we like”. Residents and relatives praised the staff describing them as “very good”, “kind” and “wonderful”. One resident said “nothing is too much trouble for them”. Residents said that the laundry service is very good. There is good information available about the home, which allows prospective residents to make an informed decision about moving in. Recruitment procedures are robust making sure that staff are suitable before they start work in the home. There are good systems in place for dealing with complaints and records to show how matters have been addressed.
Cottingley Hall J52 S19866 Cottingley Hall V226814 260505 Stage 2.doc Version 1.30 Page 6 There are good systems in place to make sure that maintenance and service checks are carried out on all equipment and services in the home. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by
Cottingley Hall J52 S19866 Cottingley Hall V226814 260505 Stage 2.doc Version 1.30 Page 7 contacting your local CSCI office. Cottingley Hall J52 S19866 Cottingley Hall V226814 260505 Stage 2.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Cottingley Hall J52 S19866 Cottingley Hall V226814 260505 Stage 2.doc Version 1.30 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 standard(s) 1, 2, 3 and 6. Residents are given good information about the home, which helps them to decide whether to move in. Residents receive contracts that tell them their rights of occupancy. Residents are assessed before moving in to make sure that the home can meet their needs. EVIDENCE: The home provides detailed information to prospective residents and their families. Brochures are available in the reception area. The statement of purpose and service user guide are one document. This gives more detailed information about the service and facilities provided at the home. Some residents said that they had visited the home and looked round before moving in. Others said that their families had done this for them. All felt that they had been given good information about the home. All residents receive a statement of terms and conditions, which sets out their rights of occupancy and the fee level. Cottingley Hall J52 S19866 Cottingley Hall V226814 260505 Stage 2.doc Version 1.30 Page 10 The nurse in charge said that all residents are assessed before admission. Preadmission assessments were seen for three residents. Two of these forms contained detailed information but the other had not been fully completed. The pre-admission assessment must contain sufficient detail for the home to be able to make a decision whether or not they can meet the resident’s needs. Staff said that the home regularly takes patients post-operatively from the Yorkshire Clinic and the Bradford hospitals. Staff said that many of these patients arrive at the home with clips or sutures in their wounds and need rehabilitation. Physiotherapists from the Yorkshire Clinic provide therapy for their patients. This standard will be assessed in more detail at the next inspection to clarify whether intermediate care, as defined in the standard, is being provided. Cottingley Hall J52 S19866 Cottingley Hall V226814 260505 Stage 2.doc Version 1.30 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 standard(s) 7, 8 and 10. Care plans vary in the amount of detail they contain and do not show fully the current needs of the resident. This means that staff cannot easily find the information they need to care for the residents. Arrangements are in place for residents to access health care services as needed. Residents’ privacy and dignity is upheld. EVIDENCE: I looked at care plans for three residents. There was some variation in the amount of detail recorded and not all of the residents’ needs were included. For example one resident is receiving radiotherapy yet there was no information for staff about how this treatment may affect the resident and the care that is needed. Other care plans showed some review and evaluation but where needs had changed the care plan had not been updated. Other information recorded in GP records and risk assessments, which showed a change in treatment, had not been included in the care plans. Without an upto-date care plan it is difficult for staff to find easily information about the resident’s current needs and how they should be met. Arrangements are in place for residents to access health care services such as the optician, chiropodist, GP and other professionals. Residents’ care records showed that there had been specialist input from a dietician, consultant
Cottingley Hall J52 S19866 Cottingley Hall V226814 260505 Stage 2.doc Version 1.30 Page 12 psychiatrist and physiotherapists. The home provides a good range of pressure relieving equipment, including specialist mattresses and cushions, to prevent and treat pressure sores. Wound care assessments and dressing plans are recorded though some of these needed updating. Residents said that they felt well cared for and praised the staff describing them as “very good”, “respectful”, “caring” and said “they couldn’t do more for you”. Staff were seen to treat residents with respect and regard for their privacy. This was confirmed by residents who said that staff knocked before entering their rooms; made sure that personal care was carried out in a way that maintained their dignity and privacy; and respected the choices and decisions they made. There are locks on all the bedroom doors and lockable facilities in each room, which allow residents to keep their own belongings safe and private. There are pay phones in discreet areas throughout the home where residents can make phone calls in private and these phones can also be used in their own rooms. Many residents have their own private phone. Cottingley Hall J52 S19866 Cottingley Hall V226814 260505 Stage 2.doc Version 1.30 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 standard(s) 12, 13 and 15. There is a good choice of activities available for the residents. Visitors are welcomed at any time. Residents enjoy the food and are offered a good choice of meals. However if food and fluid charts are being used they must be recorded properly. EVIDENCE: The home employs an activity organiser and a list of weekly activities is displayed in the home. A musical entertainer was due to visit the home on Friday. A church service is held each month in the home. Residents said that a mobile shop is brought round where they can buy such things as sweets, toiletries and stamps. The activity organiser was on holiday so there were fewer activities than usual. Residents said that there was plenty going on if you wanted to join in. Many residents were entertaining themselves in their own rooms watching television, reading or chatting with visitors. Some residents were sat outside in the garden enjoying the sunshine. I spoke with three visitors who visit the home regularly and have done so for some years. They all expressed satisfaction with the care provided to their relatives and thought the standard of accommodation was very good. They said that staff were very good and felt that they were kept informed of any changes. They said that they were always offered meals and refreshments.
Cottingley Hall J52 S19866 Cottingley Hall V226814 260505 Stage 2.doc Version 1.30 Page 14 I sat with some of the residents who were having lunch in the dining room. There was a choice of meals and each person was served individually and asked what they would like. Tables were laid attractively with tablecloths, napkins, condiments and flowers. Drinks were provided with the meal. Most of the residents were having lunch in their own rooms. Residents said that they enjoyed their meals and made the following comments about the food “it’s excellent”, “very good”, “you can have whatever you want”, “it’s wonderful – the chef comes to see me every day as I have a very poor appetite”. Nutritional assessments are recorded and the residents’ weights are recorded and monitored. Food and drink charts are recorded for some residents who have had significant weight loss or have poor appetites. Only one of these charts was seen but it had not been completed properly by staff and showed a very poor intake of food and fluids. I asked to see the current food and drink chart for this resident but staff could not find it. Cottingley Hall J52 S19866 Cottingley Hall V226814 260505 Stage 2.doc Version 1.30 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 standard(s) 16. There are systems in place to make sure that complaints are listened to and dealt with appropriately. EVIDENCE: The home has a detailed complaints policy and procedure. Records are kept of all complaints received. These clearly show the findings of any investigation, action that has been taken in response to the findings and how the complainant has been informed of the outcome. Monthly audits are recorded of all complaints received. Residents and visitors said that they felt able to raise any concerns or worries they had with the staff. One resident said that a complaint they had made had been fully investigated. An apology had been given and appropriate action had been taken to make sure that the situation did not happen again. Cottingley Hall J52 S19866 Cottingley Hall V226814 260505 Stage 2.doc Version 1.30 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 24 and 26. The home is furnished, decorated and maintained to a high standard providing residents with a comfortable and good quality environment. EVIDENCE: The home is well maintained both internally and externally. All rooms are decorated and furnished to a high standard providing comfortable “hotel” style accommodation. Communal areas are spacious and light with good quality furniture. The gardens are extensive and well maintained. Some bedrooms and the lounge have patio doors leading onto terraces overlooking the gardens. I visited many residents in their own rooms. Those who were sharing their bedroom with another resident said that they liked sharing. They said that they still had their own space for their own belongings and liked the company. Other residents who had single bedrooms said that they were pleased with their rooms and liked having their own things around them. One resident
Cottingley Hall J52 S19866 Cottingley Hall V226814 260505 Stage 2.doc Version 1.30 Page 17 whose room overlooked the garden said how she enjoyed watching the squirrels and birds. Residents told me their rooms are cleaned daily and praised the cleaning staff for their high standards. All areas of the home were very clean and there were no malodours. Cottingley Hall J52 S19866 Cottingley Hall V226814 260505 Stage 2.doc Version 1.30 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 28. Staffing levels must be reviewed to make sure that the needs of all residents are being met. The recruitment process is thorough and makes sure that staff are suitable before they start work. Staff receive induction training which makes sure that staff have the skills and knowledge to do their jobs. EVIDENCE: There were thirty-five residents in the home. Duty rotas are maintained for all staff. However it was noted that the registered manager’s hours are not recorded and this must be addressed as it is required that the duty rotas show all staff working in the home. The home employs separate catering, domestic, maintenance and administrative staff as well as the nursing and care staff. The clinical nurse manager has recently resigned and the registered manager is currently off sick. This has undoubtedly put pressure on the existing staff, although some management support is being provided from the operations manager and another BUPA home manager. Comments made by residents and staff together with my observations, indicate that staffing levels must be reviewed. Some residents said that they often had to wait a long time for staff to help them and felt that there weren’t enough staff. Staff confirmed this and said that dependency levels were high. When I spoke to staff they talked about the importance of giving residents choice and maintaining their independence. They showed a good understanding of the values that help residents to have a good quality of life. Yet they also said that they were often frustrated by the low staffing levels
Cottingley Hall J52 S19866 Cottingley Hall V226814 260505 Stage 2.doc Version 1.30 Page 19 which meant that often they had to do things for the residents rather than giving them the time and support to complete the task themselves. I looked at the recruitment files of three new staff. The records showed that all recruitment checks had been completed before the staff started work. All of the staff had attended an induction day and had then worked at least two days supernumerary with an experienced member of staff. All had received written contracts and job descriptions. Cottingley Hall J52 S19866 Cottingley Hall V226814 260505 Stage 2.doc Version 1.30 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 and 38. Care staff are appropriately supervised. Systems are in place to make sure that the health and safety of residents and staff is protected. EVIDENCE: Care staff receive regular supervision where they can discuss their job and practice with senior staff on a one-to-one basis. The maintenance man has worked at the home for fifteen years and keeps detailed records. These showed that equipment such as bed safety rails and water temperatures are checked on a monthly basis. All portable electrical equipment has been tested to make sure that it is safe. All maintenance and service records seen were up-to-date. The fire alarm system has been serviced and weekly tests of the system are carried out. Staff confirmed that they had received mandatory training in fire safety, including participating in fire drills, and moving and handling.
Cottingley Hall J52 S19866 Cottingley Hall V226814 260505 Stage 2.doc Version 1.30 Page 21 Accident reports are well recorded and filed separately to comply with the Data Protection Act 1998. Cottingley Hall J52 S19866 Cottingley Hall V226814 260505 Stage 2.doc Version 1.30 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 4 4 x x x 4 x 4 STAFFING Standard No Score 27 2 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x 3 x 3 Cottingley Hall J52 S19866 Cottingley Hall V226814 260505 Stage 2.doc Version 1.30 Page 23 No. Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard op7 Regulation 15 Requirement Timescale for action 31/09/05 2. op8 17 3. op27 18 Care plans must be kept up-todate and reflect all the needs of the resident in sufficient detail so that staff know how to meet the needs. Food and fluid charts must be 31/08/05 recorded with sufficient detail to enable any person inspecting the record to determine whether adequate diet and fluids are being provided. Staffing levels must be reviewed 31/08/05 to ensure that sufficient staff are on duty at all times to meet the needs of the residents. 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. 3. Refer to Standard op3 op6 op8 Good Practice Recommendations The pre-admission assessment should provide sufficient detail to allow the staff to decide whther the residents needs can be met. The home should meet all parts of the standard relating to intermediate care. Wound care records should be kept up-to-date.
J52 S19866 Cottingley Hall V226814 260505 Stage 2.doc Version 1.30 Page 24 Cottingley Hall Cottingley Hall J52 S19866 Cottingley Hall V226814 260505 Stage 2.doc Version 1.30 Page 25 Commission for Social Care Inspection Aire House Town Steet Rodley LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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