CARE HOMES FOR OLDER PEOPLE
Cove House Cove Road Silverdale Lancashire LA5 0SG Lead Inspector
Mrs Marie Cordingley Unannounced Inspection 20th December 2005 10:00 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 Cove House DS0000009663.V273673.R01.S.doc Version 5.0 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. Cove House DS0000009663.V273673.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Cove House Address Cove Road Silverdale Lancashire LA5 0SG 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) 01524 701219 01524 701041 The Abbeyfield Silverdale And District Society Mrs Nicola Spedding Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Cove House DS0000009663.V273673.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 1. The home may accommodate no more than 19 service users in the category OP (older persons 65 and over). The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 7th October 2005 Date of last inspection Brief Description of the Service: Cove House is registered with the Commission for Social Care Inspection to provide care and accommodation for up to 19 older people. The home is a 19th Century property, situated in its own grounds in a picturesque area overlooking Morecambe Bay. The home is one of a number operated by the Abbeyfield Society, a non profit making organisation. The registered manager (Mrs Spedding) is supported by an executive committee made up of professionals with a variety of qualifications and experience. All accommodation at the home is offered on a single room basis and 14 of the 19 rooms have en-suite facilities. There are a variety of communal areas available for the use of residents including a large dining room and several lounges. In addition, residents have the benefit of extensive, very well maintained grounds, which are fully accessible. Care is provided at the home on a 24-hour basis, including waking watch care throughout the night. Over half the carers employed at Cove House have National Vocational Qualifications in care at level 2 or above. Cove House DS0000009663.V273673.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection which meant that the manager, staff and residents did not know it would be taking place until the inspector arrived. The registered manager was available during the visit and assisted the inspector throughout. In depth discussion took place about the running of the home and a variety of documents were examined. A tour of the home was undertaken and several staff members and residents were consulted. In addition, the inspector sent written questionnaires to the residents and their families to ask them their views on all aspects of daily life at the home. A good response was received to the questionnaires. What the service does well:
The inspector received a number of completed questionnaires from residents and their families. The comments made on the questionnaires were very positive and every respondent expressed satisfaction with the service at Cove House. Comments made included; ‘‘This is like a first class hotel.’’ ‘’The staff all work as a team and that is what makes the home so good.’’ ‘’The food is always excellent, I could not fault it.’’ ‘‘They are always there to help if you need them, and very obliging.’’ During the visit the inspector consulted and observed a number of residents who all appeared to be very comfortable and relaxed in their surroundings. Residents looked well cared for and nicely dressed. Many of the residents who responded to the written survey and those consulted during the inspection were very complimentary about the quality and variety of meals provided at the home. Great satisfaction was expressed about the standard of meals and several residents confirmed that there were a number of choices available at each meal time. Cove House DS0000009663.V273673.R01.S.doc Version 5.0 Page 6 Residents at this home benefit from a very high standard of accommodation. Cove House is a large building which is well maintained and nicely furnished. All accommodation at the home is offered on a single room basis and the majority of bedrooms have en-suite facilities. Many of the rooms at the home offer wonderful views of Morecambe Bay and the local countryside. In addition, there are a variety of communal areas that residents can spend their time in, both inside and outside of the home. Staff consulted and observed during the visit appeared to be going about their roles in a professional and cheerful manner. It was confirmed during this visit that staff benefit from a good standard of training. It was also pleasing to note that the home continue to meet the national target in NVQ training, with over 50 of carers holding the qualification at level 2 or above. This home has some good systems in place for quality assurance and the registered manager is clearly aware of the importance of keeping all aspects of the service under constant review. During this visit it was found that the management team were in the process of reviewing all policies and procedures in the home. Measures had been taken to involve staff and following recommendations at the last inspection, residents and their families in this process. What has improved since the last inspection?
Following the last inspection of the home there were a number of requirements and recommendations made. It was pleasing to note during this visit that the majority of these had been addressed. Improvements had been made to systems used for planning residents’ care and the manager had completed an audit of all residents’ written care plans to ensure that they contained an accurate and up to date picture of their daily needs. In addition, new procedures had been introduced to ensure that every resident’s care plan was reviewed on a regular basis, ensuring that the home were addressing any changes in a resident’s circumstances appropriately. Following a recommendation made at the last inspection, plans had been put in place to ensure that the standard assessment process used for all prospective residents included a social history. It was also confirmed that the manager had arranged to obtain social histories for all the current residents. As recommended following the last inspection, a daily check was being made of all fridges used to store residents’ medications. In addition, improvements had been made to the home’s systems for booking in medication received, so as to ensure that an auditable running total of every drug is maintained at all times.
Cove House DS0000009663.V273673.R01.S.doc Version 5.0 Page 7 A register had been developed within the home to record all complaints made and subsequent action taken. This register was in the form of a bound and numbered book as recommended. During the last inspection, concerns were expressed about staffing levels within the home. It was found that on some occasions there were only two staff members on duty to care for 19 residents. A requirement was made in relation to this and the inspector was able to confirm during this visit that the issue had been addressed. Staffing levels had been reviewed and as a result increased. It was confirmed that there were now at least three carers on duty throughout the waking day. Initially, there was some concern expressed during the last inspection about the apparent increase in the turnover of staff at the home, but closer investigation found that the turnover was not as high as originally anticipated. However, the home have responded to recommendations made and developed a format for monitoring staff retention figures. In addition, a process for carrying out exit interviews for all staff members who leave the home has been introduced. It was confirmed during this inspection that systems for providing staff with formal, recorded supervision had been reviewed and improved. Since the last inspection, all staff had been provided with supervision and schedules had been put in place to ensue that this continued on a regular basis. What they could do better: Cove House DS0000009663.V273673.R01.S.doc Version 5.0 Page 8 The home has for some time, experienced problems with the emergency call bell system and during the last inspection a requirement was made that this be addressed. During this visit it was noted that the process of fitting a new call bell system was underway. The registered manager advised the inspector that it was hoped this work would be completed by the end of December 2005. 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. Cove House DS0000009663.V273673.R01.S.doc Version 5.0 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 Cove House DS0000009663.V273673.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the above standards were assessed during this inspection. EVIDENCE: Cove House DS0000009663.V273673.R01.S.doc Version 5.0 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): 7 Residents’ care needs are closely monitored and clearly laid out in their written care plans. Residents’ written care plans are regularly reviewed to ensure their changing needs are being addressed. EVIDENCE: The inspector viewed a selection of residents’ care plans and found these had improved since the last inspection. Following the last inspection of the home the manager had reviewed all written care plans to ensure that they contained an up to date and accurate picture of all residents’ care needs. Care plans covered all areas of daily life such as eating and drinking and personal care, and provided staff with guidance on how they should meet each individual resident’s needs. New systems had been put in place to ensure that each resident’s written care plan was reviewed on a regular basis. This regular reviewing would ensure that the home were meeting residents’ changing needs and responding appropriately to any changes in their circumstances. Cove House DS0000009663.V273673.R01.S.doc Version 5.0 Page 12 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): 12, 13, 14, 15 Residents at Cove House are able to choose form a variety of activities both inside and outside the home. Meals at the home are provided to a very good standard and in line with residents’ likes and dislikes. EVIDENCE: The home has a dedicated activities co-coordinator whose role is to work with residents on an individual and group basis and ensure that they are provided with adequate opportunities to engage in fulfilling activities. Consultations with residents confirmed that they were satisfied with the activities on offer at the home. One resident in a written questionnaire said, ‘’There is plenty to keep you occupied if you want it.’’ Records held within the home confirmed that there are a variety of activities provided on a regular basis, including regular trips, bingo, visiting entertainers and weekly Tai Chi sessions. Cove House DS0000009663.V273673.R01.S.doc Version 5.0 Page 13 It was also noted that following each activity, the activities co-coordinator carried out a written evaluation. This was to enable the home to identify which activities are popular with residents and it was pleasing to note that residents’ responses had been included in the written evaluation. It was also noted that the home enjoy close links with the local community and are visited by various community groups for example, the Women’s Institute, on a regular basis. The inspector was able to determine that the home are flexible in terms of visiting and all the families who responded to the written questionnaires confirmed that they were able to see their relatives in private and visit at any reasonable time. In addition, residents are able to entertain their guests in a number of areas within the home. There is also a special dining area available if any resident wishes to have a meal with their guests. The residents who were consulted were very complimentary about the quality and variety of meals available. One resident said ‘’The food is first class, as good as a hotel.’’ There is a very pleasant dining area within the home, which is nicely decorated. In addition, there is a smaller dining area available for residents who wish to have a meal with visitors. Nicely printed and laminated menus are provided on each table in the dining area and in viewing these, it was evident that the residents at the home are provided with a varied and nutritious diet. It was also confirmed that there were a number of alternative choices available for each main meal. The home have a system in place where all sweets are offered on a trolley at meal times, which is taken round the dining room for residents to look at. This is very advantageous, particular for those residents who may not be able to communicate clearly, as they can easily point to the sweet they want. Cove House DS0000009663.V273673.R01.S.doc Version 5.0 Page 14 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): 16 Systems are in place to enable residents to make complaints. Any complaint that is made will be dealt with quickly and efficiently. EVIDENCE: There is a written complaints procedure in place which tells the reader how to make a complaint and what they should expect to happen if they do. The procedure also explains how long a complaint should take to deal with and gives contact details for other people who may be able to help, such as the Commission for Social Care inspector. A system for recording all complaints and subsequent action taken is now in place at the home. This record confirmed that there had not been any complaints made at the home since the last inspection. In addition, the Commission for Social Care Inspection have not received any complaints about this home since its registration in 2002. Cove House DS0000009663.V273673.R01.S.doc Version 5.0 Page 15 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): 22 Equipment and adaptations required by residents must be kept in full working order to ensure their safety. EVIDENCE: The home has for some time, experienced problems with the emergency call bell system. During the last inspection a requirement was made that this be addressed. During this visit, it was noted that the process of fitting a new call bell system was underway. The registered manager advised the inspector that it was hoped this work would be completed by the end of December 2005. Cove House DS0000009663.V273673.R01.S.doc Version 5.0 Page 16 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): 27 & 29 Staffing levels have improved, which will benefit residents and ensure their needs are met. The home has careful systems in place to ensure that only suitable people are offered employment. EVIDENCE: In line with a requirement made at the last inspection, staffing levels within the home have been increased. As a result, there are now three carers on duty at all times throughout the waking day. This is a more appropriate level for a home of this size. In discussion, the manager of the home demonstrated a good understanding of the procedures to be followed when selecting and recruiting staff. In viewing a selection of staff files, the inspector was able to determine that appropriate checks had been carried out before offers of employment had been made. Such checks included CRB (criminal records bureau) checks and a POVA (protection of vulnerable adults) check. In line with recommendations made at the previous inspection, systems have been developed to formally monitor staff retention figures. In addition, procedures for carrying out exit interviews for any staff leaving the home have been implemented. Cove House DS0000009663.V273673.R01.S.doc Version 5.0 Page 17 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): 35 & 36 There are careful procedures used in the home to ensure that residents are protected from financial abuse. Staff at Cove House are provided with formal supervision on a regular basis. EVIDENCE: Systems for recording any dealings with residents’ personal monies have recently been reviewed. As a result, a number of good practice measures have been put in place to protect residents’ financial interests. Careful records are maintained of any monies held for residents and receipts are obtained for any purchases made on their behalf. Receipts are numbered so as to create an auditable trail. Cove House DS0000009663.V273673.R01.S.doc Version 5.0 Page 18 In addition, the home now has a system whereby each transaction is witnessed by two staff members, who both sign to confirm the transaction has been completed. Since the last inspection of the home, all staff had benefited from a formal recorded supervision. Systems had also been reviewed to ensure that such supervision would be offered in the future within timescales recommended in the National Minimum Standards. Cove House DS0000009663.V273673.R01.S.doc Version 5.0 Page 19 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 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 X 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 x X X X 2 X X X x STAFFING Standard No Score 27 3 28 X 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 3 X x Cove House DS0000009663.V273673.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? yes 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 OP22 Regulation 23 Requirement The call bell system must be kept in good working order at all times. Timescale for action 31/12/05 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 OP3 OP33 Good Practice Recommendations Residents’ assessments should contain a full social history. Approaches used for involving residents and their families in the home’s quality assurance systems should be formalised and written into the relevant policies and procedures. Cove House DS0000009663.V273673.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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