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Inspection on 05/02/09 for Cottingley Hall Nursing Home

Also see our care home review for Cottingley Hall Nursing Home for more information

This inspection was carried out on 5th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home operates a good admission procedure. This helps to ensure that the care home is able to meet the care needs of each person admitted. The care plans are well written and provide the carers with good person centred information about each individual. There are good risk assessments in place to help staff identify any potential care problems. Good evidence was found to show people`s health care needs are closely monitored and external health professionals are involved when needed. People told me that staff were always very helpful when they needed them. Some comments made by people were, "The staff at Cottingley provide a very good standard of care. I can only congratulate them on their efforts." "The nursing and care staff of this home are very caring and professional in their approach to their work." The standard of the food at the service is good. There are a wide variety of meals available and the cook has a good awareness of what people`s likes and dislikes are. Staff at the home have a good knowledge of safeguarding vulnerable people and people living in the home said they feel safe and protected living there. The environment has been recently redecorated throughout to a high standard. The manager adopts a thorough recruitment and selection process that helps protect people who live there. There are good management systems and processes in place that help to ensure the quality of care is monitored and improved.

What has improved since the last inspection?

The service has had a full redecoration programme recently completed. Care plans contain more person centred detail on idividuals which helps staff ensure the care needs of people are met. Evidence is in place now to show external professionals, such as dieticians and tissue viability nurses, are involved with the care of people when it is needed. Staff are aware of complaints and safeguarding issues. They provided good information to show that they would respond appropriately to any of these matters if they arose. Bed rails are now regularly checked.

What the care home could do better:

Improvement must be made to ensure the administration of medication is strictly adhered to as outlined in people`s medication administration charts. This will ensure people receive the correct therapeutic benefit from the medication.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Cottingley Hall Nursing Home Bradford Road Bingley West Yorkshire BD16 1TX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sean Cassidy     Date: 0 5 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Cottingley Hall Nursing Home Bradford Road Bingley West Yorkshire BD16 1TX 01274592885 01274532563 Telephone number: Fax number: Email address: Provider web address: www.bupa.com Name of registered provider(s): Type of registration: Number of places registered: BUPA Care Homes (BNH) Ltd care home 51 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Cottingley Hall Nursing home is on the outskirts of Bradford between Saltaire and Bingley. It can provide care with nursing for up to fifty-one older people or people with physical disabilities. However, most of the double rooms have been changed to singles which has reduced the number of people which can be admitted. This is a possible registration issue that will be reviewed at a later date. The home is an adapted, period property that has been extended in keeping with the style of the original building. It has it?s own grounds with car parking areas and pleasant gardens. Accommodation is provided in thirty single and five double bedrooms, most of which provide pleasant views of the gardens and surrounding area. Care Homes for Older People Page 4 of 27 Over 65 51 0 0 51 Brief description of the care home All except one have en-suite facilities and there are communal toilet and assisted bathing facilities throughout the building. There are two lounges, two dining rooms and a library that have been tastefully furnished and decorated. Information about the home is given to all residents in information files that are kept in every bedroom and the reception areas. Copies of this information and the homes brochures are given to people who call to look round and can be posted out on request. At the time of writing this report the cost of staying at the home varies from five hundred and twenty five pounds to one thousand one hundred pounds per week. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The accumulated evidence used in this report has included: A review of the information held on the homes file since its last inspection. Information submitted by the registered provider in the AQAA Surveys received from service users, relatives and staff. An unannounced visit to the home, which lasted eight hours. This included a partial tour of the premises. Evidence gained by direct observation, talking with people who use the service and management. Inspection of records including care plans risk assessments, medication Care Homes for Older People Page 6 of 27 administration records,and the homes policies and procedures. What the care home does well: What has improved since the last inspection? What they could do better: Improvement must be made to ensure the administration of medication is strictly adhered to as outlined in peoples medication administration charts. This will ensure people receive the correct therapeutic benefit from the medication. Care Homes for Older People Page 8 of 27 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assessed prior to moving into the home. They are provided with enough information to assist them with making a choice about moving into the home. Evidence: Three relatives spoken with said they were offered good opportunities to come and look around the home before their relatives were admitted. One said they were able to come and have a meal and stay the afternoon to try and get a feel for the home. She said this was very helpful when making a choice about moving in. Two others said it was not possible to bring their relative to visit the home because of their healthcare needs. All those people contacted during the inspection said they were provided with enough information to make their choice about taking up a place in the home. The care files of the two most recent admissions to the home showed that an Care Homes for Older People Page 11 of 27 Evidence: assessment was carried out before they were admitted. This is good practice as it allows the manager to assure herself that the staff at the home have the skills and knowledge to meet the care needs of the people who live there. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health care needs of people living in the home are well managed by the staff. People told us the staff are kind and courteous and respect their privacy and dignity. Evidence: The care files of three people were inspected. These showed good evidence that peoples care needs are assessed when they arrive at the home. Care plans looked at were person centred in their approach and provided the reader with good detail as to how the care was to be provided. Staff spoken to were aware of the care plans and their content. They said that they recorded information in the daily records to show what care they provided during each shift. Evidence was also in place that showed care plans were developed to provide for those identified care needs. Risk assessments in areas such as nutrition, tissue viability, falls and moving and handling were developed and in place. Both care plans and risk assessments showed evidence that these documents were reviewed monthly. This is good practice. Good evidence was available to show other health care professionals reviewed people regularly in the home. Two care plans showed evidence that a Care Homes for Older People Page 13 of 27 Evidence: specialist tissue viability nurse and a professional from the falls clinic had visited the home to review two people. They made care recommendations in the care documentation. It was clear from the records that this information had not been included in an updated plan and that the individuals did not benefit from the recommended good practice. This was highlighted to the registered nurses on duty and the area manager during feedback. Evidence was also in place that showed people are involved with consenting to the care that has been developed for them. The home has a system in place for auditing the care plan documentation and evidence was seen to show changes were made when they were identified in the audit. This is good practice. Staff were observed carrying out their duties during the day. They were seen to do this in a courteous and respectful manner. They were seen to knock on doors before entering and people told me this was normal practice. People spoke highly of the staff team in their approach to their work. One person living in the home was very loud and called out a lot during the inspection. Staff were observed to go about their duties as normal. This persons care plan highlighted that when this person called out staff were supposed to go to him and attempt to calm him through touch and communication, this did not happen. It was identified that the home may not be the most suitable placement for this person and the area manager agreed that this would be reviewed when the manager returned. Three people spoken to said that the staff are usually quite quick to answer the call bell. Three people spoken to said they chose when they wanted to get up and when they wanted to go to bed. one person said, Oh yes, its my choice when to get up or go to bed. No one has ever asked me to do anything i didnt want to do. People told me that staff were always very helpful when they needed them. Some comments made by people were, The staff at Cottingley provide a very good standard of care. I can only congratulate them on their efforts. The nursing and care staff of this home are very caring and professional in their approach to their work. There is a medication policy in place and evidence was seen that showed medications are regularly audited, this is good practice. Evidence was also seen to show that people who took their own medication consented to this process after assessment. Controlled drugs were stored and recorded correctly. It was noted that medications for the morning round were still be administered at 11.30 AM and during the afternoon at Care Homes for Older People Page 14 of 27 Evidence: 15:30PM. This was seen at the last inspection. People who do not receive their medication at the prescribed times may not receive the benefit from them. This must be addressed by the manager of the service. Care Homes for Older People Page 15 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides people with an interesting and varied package of activities. People are assisted to choose which ones they want to be involved with. Evidence: People told us they enjoyed the activities that were on offer at the home. An activities co ordinator has been employed by the service thirty hours per week. He provided evidence that showed good opportunities are provided to people on a regular basis. He has developed activity care plans for everyone and records showed that each person had a record made of what activity they were involved in. People who live in the home were able to provide me with a monthly pamphlet that contained what activities were planned each week. This is updated regularly. Examples of some activities planned were, bring and buy sale; mad hatters tea party; Easter celebration; Royal Ascot ladies day. The activities coordinator pointed out that there are no opportunities for people to go outside the home to visit local attractions. He said he hopes that this service will be provided in the future. People with relatives told me that they able to access the local amenities but those who are not supported in this way cannot. Care Homes for Older People Page 16 of 27 Evidence: People told us, There are good activities to involve yourself in. I was quite surprised at that. I choose what activities to get involved in. There are quite a few on offer. People told us that they have regular contact with church representatives that come to the home. One person said that her mum is seen often by a minister and regularly took communion. The cook was able to provide evidence of how she provides meals that are to the tastes of people who live there. Records were seen of peoples likes and dislikes and this was incorporated into the menus. The menus are changed regularly in an attempt to ensure people dont become bored with the food. People spoke highly of the cook and the food she provided. Positive feedback was received from people when they were asked about the quality of the food provided. The kitchen has recently been assessed by environmental health and they were awarded a Five Star rating. Care Homes for Older People Page 17 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by the safeguarding measures used by the home. Evidence: The home has a complaint procedure that reflects what each partys responsibilities are within the process. People told us they knew how to complain and that they were positive their complaints would be managed and dealt with correctly by the manager. The complaints policy was well displayed at the entrance of the home. Evidence was seen to show when a complaint is made it is investigated following the internal procedures. The home also has a safeguarding policy and procedure. The organisation has a Zero Tolerance to abuse of vulnerable people. Staff records showed people are trained in Safeguarding Vulnerable People. All staff spoken to during the inspection showed a good awareness of safeguarding issues and what to do if they were confronted with a safeguarding issue. People said they felt safe in the home and they knew what to do if they were unsure of something or someone. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with an excellent standard of environment which is maintained to a high standard. Evidence: The service has recently undergone a full refurbishment programme. This has been carried out to a very high standard. Furnishings were of good quality and many positive comments from the people who use the service were made during the day. People spoken to were very positive with regards to the standard of cleanliness of the home. Oh yes, its spotless. They are always busy cleaning my room and other areas of the home. The home couldnt be cleaner! Domestic staff are employed in good numbers. One domestic house keeper was able to provide evidence of how infection control is maintained by the cleaning programme they are involved with on a daily basis. The home is supported in maintaining the environment by a central team of experts. There are comprehensive policies and procedures in place to assist staff, including infection control and handling clinical waste. All staff and visitors are encouraged to use the alcohol hand rubs at various points in the building. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures people are provided their care packages by a staff group that are well trained and recruited. Evidence: The staffing levels on duty at the home during the site visit appeared to be appropriate for ensuring the care needs of people could be met. Evidence gathered from staff, people who use the service and relatives suggested that the the numbers of staff on duty were good. However, many comments were made about the availability of staff. Comments made were, The staff dont have the time to sit and chat with you because they are always busy. You dont seem to see them much. The staff answer the buzzers well enough but you dont get to see them very often. I dont get out of my room so its nice to get a chat when you can. This doesnt happen much. We are always busy. its a big building and when you have to go and answer a buzzer in the other unit its a long way to walk, especially when you get there and it has already been answered! Its not that we dont have the staff, its more to do with being better organised in the ways we work. The evidence gathered suggests there may be better ways of working that may enable staff to have more time to spend with people who feel isolated in their rooms. This was passed on to the area manager in feedback. Care Homes for Older People Page 20 of 27 Evidence: Positive comments were provided about the competency of the staff group as well. People said. The staff seem to know what they are doing. The staff seem very happy and competent in their roles. The organisation provides in-house training which helps develop staff through implementation of a structured training programme. All staff are provided with an induction programme that is developed around the common induction standards. This is good practice. Good evidence was available to show people are provided with a structured training programme. The majority of staff said that they are well supported by the organisation to develop their knowledge base through training. Some comments were, I had a robust induction. The organisation provides me with training, meetings and staff updates. I had a long list that had to be ticked off before I could start work by myself. The recruitment policy is in place and the recruitment files for two of the most recent employees showed that carers are correctly recruited following strict procedures. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed well. People are protected by the health and safety procedures that are implemented. Evidence: There are clear management structures and processes in place that allow the home to run smoothly. There are regional and national experts available for advice and guidance when required. There is also a comprehensive set of policies in place that are reviewed regularly. There is a clear management structure that is recognised by staff, people who live there and also relatives. Good feedback was received about the positive impact the manager has had on care provision. People told us about staff meetings, resident meeting and regular appraisal. Those staff spoken with said they received regular supervision. This was evidenced through looking at records. Care Homes for Older People Page 22 of 27 Evidence: The manager uses internal audit systems that help assure the quality of care given. Regular audits are carried out on care plans, complaints, medication and falls. Quality audits are also performed by quality review teams within the organisation. Stakeholders of the service are surveyed yearly and this information is made available to all. This is good practice. Peoples monies are held by the home in a safe. This money is only used for small things such as hairdressing, papers or cigarettes. The home keep a record and receipts of these money exchanges. People are able to manage their own finances if they wish and facilities are available in their rooms for safekeeping. Good health and safety practices were seen during the day. A complete record of the health and safety checks were seen and these were completed monthly. Regular health and safety checks take place. These give staff the opportunity to highlight health and safety issues. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The care plans must be 30/04/2009 reviewed and altered when recommendations have been made by care professionals regarding care provision. This will ensure people receive the correct care which will promote well being. 2 9 13 People who need medication 31/03/2009 must receive it at the times prescribed on their prescription charts. This will ensure they get the correct therapeutic effect from the medication. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 12 It is recommended that people living in the home are provided with regular opportunities to visit places in the Care Homes for Older People Page 25 of 27 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations local area and further afield. 2 27 It is recommended that the working systems for staff are reviewed to ensure their time is being used appropriately. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!