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Inspection on 14/09/06 for Coxhill Manor Nursing And Residential Home

Also see our care home review for Coxhill Manor Nursing And Residential Home for more information

This inspection was carried out on 14th September 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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 was bought by Caring Homes in November 2005 and this was a smooth transition the manager stated with very few problems. The operations manager told the inspector that Caring Homes have changed very little since they bought the home but they have put their own domestic and catering staff in place instead of contractors. The manager told the inspector that there had been a few complaints about the quality of the food but the chefs have continually looked at feedback from service users and are pro-active in trying to solve the problem. The manager also told the inspector that the chefs now attend resident meetings to be able to talk to the service users to address their concerns. The inspector observed good interaction and communication between the staff team and service users and visitors are welcomed into the home. The manager stated that she operated an open door policy and welcomed feedback about the service from relatives, representatives and service users. The service users that the inspector spoke with were complimentary about the service they received from the staff.

What has improved since the last inspection?

There has been an ongoing complaint to the home about security. The manager has been proactive in trying to resolve this. The police have visited and in their opinion the home has everything in place possible to make the home secure but still retain their homely environment. Security pads have now been fitted on the front door and all emergency exits are alarmed. The manager has now achieved her registered managers award. No requirements were made at the last inspection.

What the care home could do better:

There were no requirements or recommendations for improvement made at this inspection.

CARE HOMES FOR OLDER PEOPLE Coxhill Manor Nursing And Residential Home Station Road Chobham Woking Surrey GU24 8AU Lead Inspector Lesley Garrett Key Unannounced Inspection 14th September 2006 08:00 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 Coxhill Manor Nursing And Residential Home DS0000017601.V312031.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Coxhill Manor Nursing And Residential Home DS0000017601.V312031.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Coxhill Manor Nursing And Residential Home Address Station Road Chobham Woking Surrey GU24 8AU 01276 858926 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) Coxhill Manor Limited Mrs Janet Susan Varndell Care Home 74 Category(ies) of Dementia - over 65 years of age (9), Old age, registration, with number not falling within any other category (74), of places Physical disability over 65 years of age (3) Coxhill Manor Nursing And Residential Home DS0000017601.V312031.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Up to 37 beds providing nursing care for older persons from the age of 60 years Of the older people accommodated, up to 9 may be in the category DE(E) - older people suffering from dementia. Of the older people accommodated, up to 3 may be in the category PD(E), older people with a physical disability. 15th September 2005 Date of last inspection Brief Description of the Service: Coxhill Manor Nursing and Residential Home is an extended Elizabethan Manor House, situated on the outskirts of Chobham. Caring Homes Ltd. purchased the home in November 2005. Care is offered for up to seventy-four older people in single and shared rooms, all with en suite facilities. There are extensive gardens and communal areas, all of which are actively used by the service users. Car parking is available to the front of the building. The fee range for rooms are £700 (£553 for a shared room) to £1,561 and all admissions are dependent on a pre-admission assessment. Coxhill Manor Nursing And Residential Home DS0000017601.V312031.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit and key inspection was held over six and a half hours beginning at 0900 and ending at 1530. Lesley Garrett lead inspector for the service carried out the visit and the registered manager represented the establishment. They were also joined by the operations manager for the company who stayed for feedback. The inspector carried out a tour of the premises and visited some bedrooms and the communal areas, spoke to some service users, visitors to the home and some staff. Policies and procedures, care plans and recruitment folder were all sampled to aid the inspection process. The inspectors would like to thank the service users, the manager and staff for their assistance and hospitality during this inspection. What the service does well: What has improved since the last inspection? Coxhill Manor Nursing And Residential Home DS0000017601.V312031.R01.S.doc Version 5.2 Page 6 There has been an ongoing complaint to the home about security. The manager has been proactive in trying to resolve this. The police have visited and in their opinion the home has everything in place possible to make the home secure but still retain their homely environment. Security pads have now been fitted on the front door and all emergency exits are alarmed. The manager has now achieved her registered managers award. No requirements were made at 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 contacting your local CSCI office. Coxhill Manor Nursing And Residential Home DS0000017601.V312031.R01.S.doc Version 5.2 Page 7 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 Coxhill Manor Nursing And Residential Home DS0000017601.V312031.R01.S.doc Version 5.2 Page 8 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&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Pre-admission assessments take place prior to a service user moving into the home, which ensures that their needs will be met. The home does not provide intermediate care. EVIDENCE: The manager or her deputy carries out all pre-admission assessments. These are of a good standard and allow the manager to make an informed decision about the prospective service user. A standard form is used which assesses the activities of daily living and dependency levels. Care plans are then be generated from this initial assessment and this was evidenced in their individual plans of care. The home does not have intermediate care beds. Coxhill Manor Nursing And Residential Home DS0000017601.V312031.R01.S.doc Version 5.2 Page 9 Coxhill Manor Nursing And Residential Home DS0000017601.V312031.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users individual plans of care are comprehensive and demonstrate that their health needs are met. The home has policies and procedures in place for the safe handling of medications and no issues around privacy and dignity were raised. EVIDENCE: Individual plans of care were sampled by the inspector, who found them to be comprehensive and they contained detailed care plans and risk assessments. There was evidence that they were reviewed every month and the service user or their representative had contributed in the process. One of the folders casetracked the inspector read a restraint care plan and noted their good practice in measuring the gaps between the rails and this was well documented on their risk assessment. The general practitioner (G.P.) visits twice a week and the manager stated he is a good support to the home and visits will also take place in between if Coxhill Manor Nursing And Residential Home DS0000017601.V312031.R01.S.doc Version 5.2 Page 11 necessary. The manager stated that the G.P. is always available on the telephone for advice if the registered nurses need this and also stated that the home has access to specialist Parkinson and Macmillan nurses. The chiropodist visits every eight weeks and the home pays for this service. A counsellor visits every week to see individual service users if requested and will also hold group sessions. Identified in the care plans the inspector saw that falls risk assessments had taken place and the manager told the inspector that the home has a physiotherapist who will see the identified service users with a falls problem and also organises the weekly exercise class. The deputy manager told the inspector that the home uses the monitored dose system for medication administration. The inspector looked at some of the records and found there to be no gaps on the administration charts and no excess stock. The sample of controlled drugs were also checked and found to be accurate. The home disposes of their own medication and keeps a record of everything that is destroyed. The inspector witnessed no privacy and dignity issues. Staff was seen to knock on the doors prior to entering and addressing service users by their preferred name, which is documented in their individual plans of care. All shared rooms have portable curtains available and the home has a privacy and dignity policy, which the inspector saw. The manager stated that this topic is also discussed during staff induction. Coxhill Manor Nursing And Residential Home DS0000017601.V312031.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Arrangements for meeting service users social needs were a good standard and based on individual needs and expectations. Service users were able to exercise choice and control over their lives as much as they are able and visitors were made welcome by staff at any time. The presentation of food and arrangements for provision of meals was to a good standard. EVIDENCE: The home has an activities organiser who produces a programme each month and scheduled into this programme is the exercise classes and counselling sessions that already takes place. The inspector saw a varied programme and on the day of the site visit the service users were about to attend a quiz afternoon. The manager told the inspector that the activities organiser sees all service users and the devises a programme to suit their specific needs and a care plan is then drawn up in consultation with the service user. Coxhill Manor Nursing And Residential Home DS0000017601.V312031.R01.S.doc Version 5.2 Page 13 A weekly church service takes place and the manager stated that local schools, brownie packs and bell ringers have all visited the home to entertain the service users. On the day of the site visit the inspector saw many visitors coming into the home. The manager said she has an open door policy and her office overlooks the main lounge so she is always visible to them. Relatives are always welcomed to eat at the home and this is not charged for. A popular activity held for the relatives and friends of the service users is the buffet lunch held on Boxing Day and the candle lit supper on New Years Eve, which the manager told the inspector about. Many choices are given to service users about the clothes they wish to wear, the name they prefer to be called by and the activities they wish to attend. The inspector observed these choices being given to service users. The home has more than one lounge and dining room and they can choose where to sit also. During the site visit the inspector visited the kitchens and found that the routine checks carried out by the chef had been completed and these included fridge and freezer temperatures and cleaning schedules. Since the last inspection the home has changed from contract caterers to employing their own chefs. The home now has three chefs and kitchen chefs to help with the meals. The manger said that many of the complaints received this year were focused on the food and to address this chefs see all service users and attends their regular meetings to try to find solutions. The inspector did not sample the lunch but spoke with some service users who told the inspector they had enjoyed their lunch but knew who to complain to if it was not up to standard. The chefs make cakes for the afternoon tea and the inspector sampled this and found it to be of a good quality. Coxhill Manor Nursing And Residential Home DS0000017601.V312031.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has a complaints policy for the home and any concerns that service users may have are taken seriously. There is a safeguarding adults policy, which will protect the service users from abuse. EVIDENCE: The home has a complaints policy, which is displayed and available in the service user guide, which the inspector saw. The manager stated that she had received ten complaints this year and all but one has been resolved within the homes stated timescale. These were available for the inspector to see in the complaints log. There is one complaint that has not yet been resolved but the Commission has been made aware of this problem. A safeguarding adults policy for the home was available for the inspector to see and the homes local policy was in-line with the Surrey Multi Agency procedures. The manager stated that training has taken place for all staff including training provided by Surrey and the subject is also covered during induction for new staff. The home has had no local authority referrals for safeguarding adults this year. Coxhill Manor Nursing And Residential Home DS0000017601.V312031.R01.S.doc Version 5.2 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): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users live in a safe well-maintained environment, which is clean, pleasant and hygienic. EVIDENCE: The home is accessible and safe and the inspector noticed during the tour that it was also well maintained. The manager stated that they have a programme of routine maintenance and all rooms are decorated when they are vacant and whenever necessary. Three maintenance persons are employed and when the inspector spoke with them they stated that they are always busy. The home has a large downstairs lounge, which is very light and airy and the chairs and coffee tables are arranged in groups around the room. The inspector saw service users in this room sitting and chatting to each other and visitors made welcome sitting with their relatives and enjoying afternoon tea. Coxhill Manor Nursing And Residential Home DS0000017601.V312031.R01.S.doc Version 5.2 Page 16 The manager stated this is the room used for any large function the home has and in particular on Boxing Day when all service users, and their families or representatives are invited for a buffet lunch. The inspector had discussions with the manager and operations manager about the top floor where there are a small amount of rooms for service users with dementia. This floor seemed small in comparison with the rest of the home. The managers stated that the type of service users that are taken for this floor have to be mobile as there are some steps and they have access to the gardens and the other lounges. The gardens are large and accessible for service users with seating and tables and shade available for their use. A popular feature is the fishpond as you enter the garden, which is well protected with fencing. The home has no CCTV cameras in place but has recently installed a push button entry system for the front door as this is now locked when the receptionist is not on duty and all the fire exits are alarmed. A recent report by the police reassured the manager that the home was safe and secure. The home has a good size laundry, which has a dirty and clean side. All laundry is delivered back to the service users rooms either in boxes or on hangers. The manager told the inspector that the laundress has had training in infection control. Coxhill Manor Nursing And Residential Home DS0000017601.V312031.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staffing levels in the home are sufficient to meet the needs of service users. The home is able to demonstrate that trained and qualified staff that is able to carry out their role competently supports service users. The home ensures that adequate checks are completed prior to staff working in the home and staff training is carried out on a regular basis. EVIDENCE: The inspector sampled staff rotas that were sent with the pre-inspection questionnaire and also the rota on the day of inspection. It demonstrated the home had adequate staff on duty and a good skill mix. The manager stated that the home has not changed the staffing numbers since they have changed owners but that she always looks at the dependency levels of the service users. The manager stated that 50 of the care staff has the National Vocational Qualification (NVQ) at level 2. The operations manager told the inspector the company has a commitment to NVQ training and this happens at the home and is on-going. The manager also told the inspector that all new staff receives induction training and this is linked to the skills for care. Coxhill Manor Nursing And Residential Home DS0000017601.V312031.R01.S.doc Version 5.2 Page 18 The inspector sampled four employment folders and found them to contain all the necessary information that protects the service users in the home. The manager showed the inspector the training plan for the year for all staff. It included all the mandatory training for example safeguarding adults, fire awareness, basic food hygiene, moving and handling and health and safety. All staff receives induction training and the manager stated that this is linked to the skills for care. Coxhill Manor Nursing And Residential Home DS0000017601.V312031.R01.S.doc Version 5.2 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 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a home that is managed by an experienced person who discharges her responsibilities fully. There are good quality audits in place and the service users views are sought. Financial interests of service users are safeguarded and their health and safety is promoted and protected. EVIDENCE: The manager has been in post for three and a half years and she told the inspector that she has now completed her registered managers award. She Coxhill Manor Nursing And Residential Home DS0000017601.V312031.R01.S.doc Version 5.2 Page 20 undertakes periodic training and she stated that she had recently completed training in diversity and medication. The manager told the inspector that regular service user surveys are carried out at the home. This year there will be at least two as there has been a change of company. The results are fed back to the service users during a resident’s meeting and the relatives or representatives are also invited. The manager also stated that if any systems are changed within the home this is fed back to the service users by means of a meeting. The inspector met with the service user who is head of the resident’s association. He will arrange meeting for the service users when required and always invites the manager to these sessions. The home also has a suggestion book which is available in reception and any comments are acted upon by the manager and the inspector has received positive feed-back from the service users that she spoke with and comment cards received at the Commission. The inspector met with the administrator who told the inspector that the home keeps very little money for personal use by service users. If this service is requested the administrator keeps separate records for each service user and receipts are kept and no money is pooled. Valuables can be kept in the safe for short periods until their family or representative collects it. The inspector then saw that this is then signed for. The home has three full time maintenance people and the inspector met with two of them. There is a routine maintenance programme and all rooms are decorated when empty and the inspector saw an example of that. All routine maintenance checks have taken place for example the fire extinguishers, gas checks and legionella checks. The inspector also used the pre-inspection questionnaire for information about the safety check and records kept by the home. Coxhill Manor Nursing And Residential Home DS0000017601.V312031.R01.S.doc Version 5.2 Page 21 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 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Coxhill Manor Nursing And Residential Home DS0000017601.V312031.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Coxhill Manor Nursing And Residential Home DS0000017601.V312031.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Coxhill Manor Nursing And Residential Home DS0000017601.V312031.R01.S.doc Version 5.2 Page 24 - 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!