CARE HOMES FOR OLDER PEOPLE
Cove House Cove Road Silverdale Lancashire LA5 0SG Lead Inspector
Mrs Marie Cordingley Unannounced Inspection 7th October 2005 12:00 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.V251882.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.V251882.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 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Cove House DS0000009663.V251882.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The home may accommodate no more than 18 service users in the older person (OP) category. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 3rd March 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.V251882.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and as such, the manager, staff and residents were not aware it would be taking place until the inspector arrived. The registered manager was on a training course at the time of the visit so the inspector was assisted by the assistant manager, Cheryl Rogers. The inspector discussed various aspects of the running of the home with the assistant manager and other staff members. In addition, the inspector was able to consult a number of residents both during and prior to the inspection. Before the inspection, written questionnaires were issued to residents, their families and visiting health care professionals. A good response was received from these questionnaires. As part of the inspection a number of documents were examined and a tour of the home was undertaken. The inspector also carried out a case tracking exercise. This involved carrying out a close examination of selected residents’ care from the point of their admission. What the service does well:
Cove House DS0000009663.V251882.R01.S.doc Version 5.0 Page 6 During this and previous visits the inspector has received very positive feedback from residents, their families and professionals who regularly visit the home. All the residents who were consulted at the time of the visit expressed satisfaction at the standard of care at Cove House and spoke highly of staff. One resident said ‘’It is lovely to stay here, I am very happy. It is the next best thing to being in your own home’’ Residents consulted during the inspection looked well cared for and content in their surroundings. In addition, all those consulted said they were satisfied with all aspects of daily life such as the provision of meals and activities. The inspector received a good response to the written questionnaires that were issued. All the residents or their representatives who responded said that they were well cared for and treated with respect. Other comments received in writing included; ‘’They are all very nice here, they do anything for you.’’ ‘’My mother has been very well cared for over the last two years.’’ ‘The staff are excellent at Cove house, always courteous and considerate.’’ ‘’There is a good choice of food and a very good chef.’’ ‘’Words cannot describe how good it is, it’s like a first class hotel.’’ Comments received from visiting professionals were also very positive. A GP who was surveyed, commented that staff at the home were always willing to care for residents with complex conditions for as long as possible. A social worker commented on the fact that the manager was always happy to spend time discussing issues no matter how busy she was. 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 is a variety of communal areas for residents to choose from. It was confirmed during this inspection that the home continue to meet the national target to have 50 of their care staff qualified in care to NVQ level 2 or above. Cove House DS0000009663.V251882.R01.S.doc Version 5.0 Page 7 What has improved since the last inspection? What they could do better:
During this visit the inspector expressed concern about staffing levels within the home. The home now accommodate up to 19 residents but in viewing rotas it was established that at certain times throughout the day there are only two staff members on duty. Staffing levels must be reviewed taking into account the layout of the building and the personal care needs of some of the residents who live at the home. During discussions held at the time of the visit the inspector received a complaint about the call bell system within the home. Further investigation confirmed that the call bell system had for some time been problematic, on one occasion going off in the middle of the night. The assistant manager was advised at the time of the visit that this issue must be addressed without delay. It was noted during this visit that the turnover of staff at the home had increased since the last inspection. The inspector recognises that one staff member had retired and another had been promoted within the organisation. However, it is recommended that systems be introduced to monitor the turnover of staff as part of the home’s quality assurance systems. In addition,
Cove House DS0000009663.V251882.R01.S.doc Version 5.0 Page 8 the introduction of exit interviews for all staff leaving the home would be of value. There are systems in place for annual appraisal and regular supervision of staff. However, when viewing records it was noted that supervision is not taking place on a regular basis for all staff members. This area should be reviewed to ensure that all staff have access to formal recorded supervision at least six times each year. In line with recommendations made at the last inspection the home have now obtained a fridge for the storage of residents’ medication. It is recommended that a daily temperature check be made of the fridge to ensure that residents’ medication is being stored at the desirable temperature. The inspector viewed a number of residents’ care plans during the visit. There is a good system at the home for care planning, which is both user friendly and comprehensive. However, during this visit it was noted that the system is not being used to its full potential. In particular, residents’ care plans did not always give a full picture of their current circumstances. This issue was discussed at the time of the visit with the assistant manager. 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.V251882.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.V251882.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): 3. Standard 6 is not applicable to this home. The home obtain a detailed knowledge of a resident’s care needs prior to their admission therefore enabling them to implement an effective care plan. EVIDENCE: The home have a system whereby all prospective residents are visited in their own home (or current circumstances) by the manager and another senior member of staff. During this visit all aspects of a resident’s care needs are discussed and a record of all of this information (an assessment) is completed. The information included in an assessment is then used to develop a care plan which addresses all the resident’s needs. The inspector viewed a number of residents’ assessments and noted that they covered areas of daily living such as eating and drinking, personal care and mobility. Assessments were found to be of good quality and comprehensive. However, they would be further enhanced if they included a more in depth social history of an individual. A recommendation has been made to this effect in this report.
Cove House DS0000009663.V251882.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, 8, 9 & 10 Staff at the home plan for residents’ care needs and ensure that any required health care support is provided. Improving care planning processes will further ensure that all residents’ needs are met. EVIDENCE: The home have a useful format in place for planning residents’ care but this is not always used to its full potential. When case tracking certain residents, it was apparent that their written care plans did not always fully reflect their current circumstances. For example, concerns had been identified in relation to one resident’s excessive alcohol consumption and associated risk of falling. The inspector was aware of these concerns through discussions held, but on viewing the resident’s care plan could not find any reference to them. In another resident’s daily diary notes, reference had been made to the fact that she had been admitted to hospital earlier in the year. However, whilst the inspector was able to establish that the resident had been discharged, there was no information on her care plan about her stay in hospital or outcome of tests carried out during her stay there.
Cove House DS0000009663.V251882.R01.S.doc Version 5.0 Page 12 The home need to ensure that all residents’ care plans are reviewed regularly and updated to reflect any change in a resident’s circumstances. Through discussion with residents and visiting health care professionals, it was established that the home ensure residents have access to health care when they need it. All the health care professionals who completed questionnaires for the inspector said that staff at the home demonstrated a good understanding of residents’ needs and always followed the advice they gave. Relevant risk assessments were found to be in place in relation to areas such as pressure sores and falling. These were completed to a good standard and provided staff with clear guidance in how to reduce the risks identified. There are good systems in place for the safe receipt, storage, administration and delivery of residents’ medication. The inspector viewed the home’s medication stock which was found to be well organised and all items appropriately stored. In line with recommendations made at the last inspection, the home have now obtained a fridge for the sole purpose of storing medication. It is recommended that a daily check be made to ensure that the fridge is operating at the correct temperature. One resident was self medicating and it was confirmed that there was a signed disclaimer and an appropriate risk assessment in relation to this. The risk assessment was of a very good standard taking into account all the relevant areas needing to be considered, such as any difficulties the resident may have in seeing bottles or remembering the time his medication was due. In viewing the records of medication received at the home and medication administered, it was noted that there had been some minor errors made. Procedures need to be reviewed to ensure this does not happen again. Cove House DS0000009663.V251882.R01.S.doc Version 5.0 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): None of the above standards were assessed during this inspection. EVIDENCE: Cove House DS0000009663.V251882.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 & 18 There are systems in place to ensure that residents are able to raise concerns and that such concerns are dealt with quickly and effectively. Managers and staff at the home are aware of how to respond in a situation where an incidence of abuse is alleged or suspected. EVIDENCE: There is a complaints procedure in place, which tells residents and their families how to go about making a complaint and also advises on how long it should take for the home to deal with their complaint. All the residents who responded to the written survey said that they knew about the complaints procedure and what to do if they had any concerns. The inspector was advised that there had been two complaints since the last inspection. However, there was no record available within the home at the time of the visit. The assistant manager was advised that a record of all complaints must be held within the home at all times. A requirement has been made in respect of this matter. The Commission for Social Care Inspection have not received any complaint about this home since its registration in 2002. In accordance with recommendations made at the last inspection, guidance provided to staff and managers in how to respond to an allegation or suspicion of abuse have been developed. The guidance now includes a flow chart and
Cove House DS0000009663.V251882.R01.S.doc Version 5.0 Page 15 relevant contact numbers, for example numbers of local social services departments. Cove House DS0000009663.V251882.R01.S.doc Version 5.0 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): 19, 20, 21, 22 & 26. Residents at Cove House are provided with a high standard of accommodation. Equipment and adaptations required by residents must be kept in full working order. EVIDENCE: Cove House is a large home which is very well maintained and furnished to a high standard. There are a variety of communal areas for residents to access both inside the home and within the grounds. All accommodation at the home is offered on a single room basis, some with en suite facilities and there are ample bathrooms and toilets conveniently located around the home. Residents consulted at the time of the visit were very satisfied with the standard of accommodation. One resident said ‘’It is like a five star hotel and always so clean.’’ Cove House DS0000009663.V251882.R01.S.doc Version 5.0 Page 17 In discussion, the inspector was advised that the call bell had been causing some inconvenience to residents. Further investigation confirmed that the home had been experiencing problems with the call bell system for several weeks, despite a number of attempts by a qualified person to mend it. A correctly working call bell system is essential to ensure the safety and well being of residents. As such, this issue must be addressed without delay. A requirement relating to this has been made in this report. Cove House DS0000009663.V251882.R01.S.doc Version 5.0 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 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, 28 & 30. Staffing levels are not always adequate to meet the needs of people living at Cove House. EVIDENCE: During this visit the inspector raised concerns in relation to staffing levels. It was found that on occasions, generally the evenings, there were only two staff members on duty for 19 residents. Taking into account the personal care needs of some of the residents who live at the home and the layout of the building, two carers is not adequate. A requirement has been made in respect of this. When examining figures provided by the manager of the home, it was evident that staff turnover had increased since the last inspection. The inspector is aware that one staff member has retired and another has been promoted within the organisation. However, it is recommended that a system be introduced to monitor staff retention figures and that consideration be given to introducing exit interviews for staff members who leave the company. The home continues to meet the national target for NVQ training. Over 50 of carers hold care qualifications at NVQ level 2 or above. Cove House DS0000009663.V251882.R01.S.doc Version 5.0 Page 19 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): 31, 33 & 38. The management team at Cove House are competent and suitably experienced. There are very good systems in place for monitoring quality which involve residents and their families. EVIDENCE: There is a suitably qualified and experienced manager in place at Cove House, who is registered with the Commission for Social Care Inspection. In discussion, the home’s assistant manager advised the inspector that she was about to commence NVQ training in care and management at level 4. The registered manger is supported by an executive committee who have very good systems in place to monitor quality. In line with the Care Homes Regulations 2001, a member of the committee carries out an unannounced visit to the home on a monthly basis. During this visit, a number of areas are examined and staff and residents are consulted. A
Cove House DS0000009663.V251882.R01.S.doc Version 5.0 Page 20 report of this visit is forwarded to the Commission each month and in a timely fashion. The home has a number of external systems in place to monitor quality, including the RDB (Residential and Domiciliary Benchmarking) award and the Investors in People award. To retain both these awards the home must continue to meet standards set by the awarding bodies and are regularly inspected. All the policies and procedures used in the home had been recently reviewed or were in the process of being reviewed. Those viewed were found to be written to a good standard, reflecting the everyday working practices of the home and providing good, clear guidance to staff. In discussion, it was confirmed that staff are involved in this process. However, there are no formal arrangements currently in place to involve residents and their families. A recommendation was made in respect of this. Residents’ meetings are held on a monthly basis and minutes of the meetings confirmed that a high number of residents chose to attend them. A number of areas are discussed during the meetings and the inspector was also able to confirm that requests made by residents during the meetings had been followed through. A recommendation was made to consider inviting friends and families of residents to the meetings. As earlier stated, records examined confirmed that supervisions were not being carried out as frequently as is recommended in the National Minimum Standards. Procedures should be reviewed to rectify this. The home has a Health and Safety policy in place which is supported by a number of related procedures, for instance COSHH (Control of Substances Hazardous to Health) and Moving and Handling. A number of records in respect of health and safety were examined including the fire book, records of electrical checks, gas checks and passenger lift servicing. Records confirmed that all such checks are carried out on a regular basis. Cove House DS0000009663.V251882.R01.S.doc Version 5.0 Page 21 Cove House DS0000009663.V251882.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 3 2 X X X 3 STAFFING Standard No Score 27 2 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X X X X 3 Cove House DS0000009663.V251882.R01.S.doc Version 5.0 Page 23 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. 2. 3. 4. 5. Standard OP7 OP22 OP27 OP36 OP37 Regulation 15 23 18 18 17 Requirement Care plans must be regularly reviewed and updated to reflect residents’ needs. The call bell system must be kept in good working order at all times. Staffing levels must be adequate to meet the needs of residents accommodated at the home. Staff at the home must be adequately supervised. A record must be kept within the home of all complaints made and action taken. Timescale for action 31/10/05 15/10/05 07/10/05 30/11/05 14/10/05 Cove House DS0000009663.V251882.R01.S.doc Version 5.0 Page 24 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. 4. 5. 6. 7. Refer to Standard OP3 OP9 OP9 OP27 OP27 OP32 OP32 Good Practice Recommendations Residents’ assessments should contain a full social history. The temperature of the fridge used for storing medication should be checked on a daily basis. Systems for booking in medication received at the home should be reviewed to ensure no errors are made. A system should be introduced to monitor staff retention figures. Consideration should be given to introducing exit interviews for those staff members leaving the home. Families and friends of residents should be invited to resident’s meetings. Systems should be introduced to include residents in the reviewing of policies and procedures. Cove House DS0000009663.V251882.R01.S.doc Version 5.0 Page 25 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
© 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 Cove House DS0000009663.V251882.R01.S.doc Version 5.0 Page 26 - 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!
