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Inspection on 16/05/05 for Coxwell Hall and Mews Nursing Home

Also see our care home review for Coxwell Hall and Mews Nursing Home for more information

This inspection was carried out on 16th May 2005.

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 provides a service tailored to individual needs through the key worker system where the care of each person is the responsibility of a named member of staff. Staff receive clear direction. Residents` hobbies and interests in the Mews are reflected in the activities programme, and activities are seen as an important part of daily life. Life histories are recorded on all residents as a matter of course.

What has improved since the last inspection?

The Service User`s Guide and the Statement of Purpose are now compliant with the Regulations. Care planning. Supervision arrangements. It is now the home`s policy to record all creams applied. Beds have been rearranged so that all call bells can be reached from there. All fire exits were being kept clear. It is the policy to confirm in writing the current medications of residents who have come for respite with their GP. An evacuation procedure has been drawn up and was out for consultation. 148 pictures have been bought to liven up the corridors. Staff turnover has decreased.

What the care home could do better:

The amended complaints procedure should be in the Statement of Purpose and the Service User`s Guide. Provide residents with a payhone which can be used in private. Address the unhygienic odours downstairs in The Mews. Keep each resident`s care plan individually.Renovate or replace worn furniture and redecorate chipped paintwork. Implement the 2005-06 refurbishment plan to provide the recommended furniture and lockable doors. Highlight safety issues to staff.

CARE HOMES FOR OLDER PEOPLE Coxwell Hall & Mews Nursing Home Fernham Road Faringdon Oxfordshire SN7 7LB Lead Inspector Lilian Mackay Unannounced 16 May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Coxwell Hall & Mews Nursing Home H57-H08 S27145 Coxwell Hall & Mews V222602 160505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Coxwell Hall & Mews Nursing Home Address Fernham Road, Faringdon, Oxfordshire, SN7 7LB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01367 242985 01367 241594 info@coxwellcare.org Sovereign (Coxwell Hall) Ltd Mrs Carol Burnett Care Home with Nursing 68 Category(ies) of Dementia - over 65 years of age (37), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (37), Old age, not falling within any other category (31). Coxwell Hall & Mews Nursing Home H57-H08 S27145 Coxwell Hall & Mews V222602 160505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The total number of persons that may be accommodated at any one time must not exceed 68, of which 37 may be in either the DE (E) or MD (E) category. Date of last inspection 08 February 2005 Brief Description of the Service: Coxwell Hall and Mews is registered to provide care for up to 68 people from the age of 60. The company voluntarily limits occupancy to 27 in Coxwell Hall and 36 in Coxwell Mews to reduce the number of double rooms to one on each unit. The home has two separate units, linked by a covered walkway. Coxwell Hall provides care for people with general care needs and Coxwell Mews specialises in people with dementia. Registered nurses are on duty 24 hours a day to provide nursing care and to supervise care assistants. En-suite facilities of toilet and washbasin are provided in Coxwell Mews in addition to two baths and two showers. Three bedrooms there have full ensuite facilities. In the Hall all rooms have en suite facilities of toilet/washbasins except for one room on the first floor and there are two baths and two showers. There are communal lounges and dining rooms in each unit. Coxwell Hall is an early 19th century Grade 2 listed building, whilst the Mews was purpose-built. It is set in its own grounds on the outskirts of the market town of Faringdon in Oxfordshire. The Hall has a pleasant private patio and the Mews also has its own private secure garden. Both have attractive garden furniture. Coxwell Hall & Mews Nursing Home H57-H08 S27145 Coxwell Hall & Mews V222602 160505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit took place between 11.00am and 3.30pm on Monday 16 May 2005. The purpose of the visit was to see how the home is meeting the National Minimum Standards for care homes for older people. The inspectors spoke to eight residents and four relatives and staff members on duty. The inspectors observed staff interactions with residents and examined residents’ files. Inspectors saw caring and respectful interactions between staff and residents. One resident said, “I like it here. I like the staff.” Another resident said, “I quite like the food. I’m fairly happy here.” Another resident said “I like it here.” One resident’s relative said, “Fantastic. They [Staff] do marvellously. I wish they could go out more to some pretty gardens…more little trips. The staff are marvellous with X, I don’t think we could have got anywhere better.” Another resident’s relative said, “It can be smelly sometimes. There are a lot of small things being done. We enjoy it.” Another resident’s relative said, “The first four weeks were fantastic. Her room was spotless and staff were always popping in. Anything she wanted they would get it for her. I had to wait two days to hear X was ill. Staff are really helpful. The staff are brilliant but it is difficult to understand what they are saying. Sometimes staff don’t understand what residents are saying and get it wrong. This is frustrating. They are patient. They did a really good job of nursing X and got the doctor in straight away. X didn’t like the food. It was not hot when she got it. Sometimes the meat is not cooked long enough.” Another resident’s relative said, “They [Staff] are very caring. She eats it [the food] all.” Another resident’s relative said, “X enjoys the food. Some of the furniture is advanced in age. I’m very satisfied with the care. Great! They [Staff] come and make her laugh. Everybody knows her well.” Another resident’s relative said, “I think it’s great here. They [Residents] are well looked after, staff are nice and helpful, the food is nice. Quite a bit goes on. I would come in myself. It’s very clean. X is very clean.” The inspector would like to thank the residents and relatives, the staff members on duty and the manager for their assistance, hospitality and courtesy during this inspection. Coxwell Hall & Mews Nursing Home H57-H08 S27145 Coxwell Hall & Mews V222602 160505 Stage 4.doc Version 1.30 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The amended complaints procedure should be in the Statement of Purpose and the Service Users Guide. Provide residents with a payhone which can be used in private. Address the unhygienic odours downstairs in The Mews. Keep each resident’s care plan individually. Coxwell Hall & Mews Nursing Home H57-H08 S27145 Coxwell Hall & Mews V222602 160505 Stage 4.doc Version 1.30 Page 7 Renovate or replace worn furniture and redecorate chipped paintwork. Implement the 2005-06 refurbishment plan to provide the recommended furniture and lockable doors. Highlight safety issues to staff. 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. Coxwell Hall & Mews Nursing Home H57-H08 S27145 Coxwell Hall & Mews V222602 160505 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Coxwell Hall & Mews Nursing Home H57-H08 S27145 Coxwell Hall & Mews V222602 160505 Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 3. Standard 6 is not applicable as intermediate care is not provided. The Statement of Purpose and the Service User’s Guide did not contain the latest version of the complaints procedure. Amendments have since been made to address this. The admission procedure is good. EVIDENCE: The Statement of Purpose and the Service User’s Guide have been updated frequently and copies sent to CSCI for information. The complaints procedure in the Service User’s Guide and the Statement of Purpose did not indicate that a complaint can be referred to CSCI at any time. This was however amended at the time of the inspection visit. The admission procedure includes an assessment prior to the resident’s admission and ensures their needs can be planned for. There is a key worker system in operation where the care of each person being supported is the responsibility of a named member of staff. Coxwell Hall & Mews Nursing Home H57-H08 S27145 Coxwell Hall & Mews V222602 160505 Stage 4.doc Version 1.30 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 standard(s) 7 and 8 Care planning is effective and residents’ health, social and personal care needs are met. The head of care is a skilled and experienced nurse and has systems in place to ensure that the physical and mental health care needs of the residents are fully met. EVIDENCE: Residents have their health care needs met by the community health services. The inspector saw care plans which included appropriate risk assessments and detailed instructions for staff to enable them to carry out the care needed by the individual. Care plans are reviewed regularly, are up to date and are drawn up with the involvement of the resident and/or relatives. The inspector tracked the care of residents to see how health care needs are met. Records seen show that residents see a GP when the need arises, and are referred as necessary to other health care professionals in the community setting or at a hospital. Individuals are supported to maintain their personal care, and help is given when needed. Outcomes of risk assessments are acted Coxwell Hall & Mews Nursing Home H57-H08 S27145 Coxwell Hall & Mews V222602 160505 Stage 4.doc Version 1.30 Page 11 on, for instance regarding pressure wounds or moving and handling residents. Where appropriate, equipment is provided. Life histories are recorded with the help of families, and daily activities for residents are developed with this in mind. Activities are seen as an important part of the daily routine, and a member of staff is allocated daily to work with the activities coordinator. Relatives told the inspector that they were satisfied with the care at The Mews. Coxwell Hall & Mews Nursing Home H57-H08 S27145 Coxwell Hall & Mews V222602 160505 Stage 4.doc Version 1.30 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 standard(s) 12,13,14 and 15. Residents are encouraged to take part in their chosen activities some of which are within the community. The current telephone arrangements do not meet residents’ needs. Residents’ family, friends and representatives are made welcome. Residents have a voice through regular residents’ meetings. The meals offer choice and variety. The food preferences and eating habits of residents are respected. EVIDENCE: Residents can take part in activities such as listening to music, reading the daily newspapers, going on outings, playing games, doing quizzes, having sing-a-longs and attending shows. The payphone in the Mews was not working. The fact that use of the mobile phone is free may be discouraging some residents from requesting to use it. Feedback indicates that residents do not feel they have easy access to a phone. Coxwell Hall & Mews Nursing Home H57-H08 S27145 Coxwell Hall & Mews V222602 160505 Stage 4.doc Version 1.30 Page 13 Regular residents/relatives meetings are held to listen and respond to views and opinions. There is a daily menu which provides choices. Residents’ choice is recorded individually daily. The inspector saw residents having lunch in the dining room. Staff skilfully helped those unable to manage on their own. The inspector saw the lunch menu of the day, showing a choice of meals. During the day drinks were offered regularly to residents, and the inspector understood from one resident that a cooked breakfast was available if requested. Coxwell Hall & Mews Nursing Home H57-H08 S27145 Coxwell Hall & Mews V222602 160505 Stage 4.doc Version 1.30 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 standard(s) 16 and 18 The complaints procedure is adequate. Residents are protected as far as possible from abuse. EVIDENCE: The complaints procedure was amended whilst inspectors were present to indicate that complaints can be referred at any stage to CSCI. It is Sovereign management policy to report any serious complaints to CSCI. The head of care in The Mews was aware of the home’s policy and procedure to protect residents from abuse, and knew what actions to take in the event of an allegation. No allegations of abuse have been made since the last inspection. CSCI have received no complaints about this service since the last inspection. Coxwell Hall & Mews Nursing Home H57-H08 S27145 Coxwell Hall & Mews V222602 160505 Stage 4.doc Version 1.30 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 standard(s) 19,22,24 and 26. Whilst, for the most part the environment is well maintained, some improvements have been recommended. The home provides a safe and comfortable environment. Specialist equipment is provided where needed. Residents are satisfied with their bedrooms. The hygiene and control of infection procedures are not as effective as they should be. EVIDENCE: Whilst the environment is mostly well maintained badly chipped woodwork and worn furniture detract from the home’s appearance. Coxwell Hall & Mews Nursing Home H57-H08 S27145 Coxwell Hall & Mews V222602 160505 Stage 4.doc Version 1.30 Page 16 Beds have been rearranged to ensure that all call bells can be reached from the bed. A blanket risk assessment has been carried out on rooms where the recommended minimum furniture and lockable doors are not provided. The 2005-6 refurbishment plan will address these shortfalls. The WCs and bathrooms in The Hall were very clean. There was an unpleasant odour, similar to that of urine, in the downstairs area of The Mews, the home’s sluicing facility was broken and commodes were not being properly disinfected. The laundry procedures need to be improved so that items awaiting washing are not piled on the floor. Coxwell Hall & Mews Nursing Home H57-H08 S27145 Coxwell Hall & Mews V222602 160505 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29. The deployment and number of staff is sufficient to meet residents’ needs. Staff recruitment procedures are robust and safeguard residents and progress has been made in addressing staff turnover. EVIDENCE: Residents’ needs were being met by the staff on duty at this time. Criminal Records Bureau checks are routinely conducted of staff prior to employment. In exceptional circumstances, where the staff member has to start before receipt of their Criminal Records Bureau check, a check of the Protection of Vulnerable Adults [POVA] list is undertaken, appropriate supervision arrangements put in place and the position explained to residents. Coxwell Hall & Mews Nursing Home H57-H08 S27145 Coxwell Hall & Mews V222602 160505 Stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,36,37 and 38. Leadership, guidance and direction is given to staff to ensure residents receive consistent care. The manager is registered with CSCI and is accountable for the service along with the responsible individual who is the managing director of Sovereign [Coxwell Hall] Ltd. Staff are well supervised. The records inspected were up to date and accurate but should be kept individually. With one exception the home was promoting and protecting the health and safety of residents. Coxwell Hall & Mews Nursing Home H57-H08 S27145 Coxwell Hall & Mews V222602 160505 Stage 4.doc Version 1.30 Page 19 EVIDENCE: Monthly unannounced reports on the management of the home are undertaken diligently by the managing director personally and copies of these sent to CSCI for information. Visitors to Coxwell Hall/Mews are encouraged to complete a Quality Scale Survey. CSCI inspection reports are left beside the Visitors Book for information. The head of care has attended supervision training and training is organised for the care supervisors. A system is in place to manage supervision and all care staff will have recorded formal supervision in the near future. Informal supervision happens on a daily basis, and team meetings are used to ensure that the home’s policies and procedures are followed. Residents’ records are kept together in one file, which means that only one member of staff can record information at any one time, and making it more difficult to protect residents’ private information. Residents’ files should be kept individually to ensure confidentiality. A battery charger left out in a corridor could have caused an accident. Coxwell Hall & Mews Nursing Home H57-H08 S27145 Coxwell Hall & Mews V222602 160505 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 1 14 4 15 3 COMPLAINTS AND PROTECTION 3 x x 3 x 3 x 2 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 Standard No 16 17 18 Score 3 x 3 3 3 x x x 3 2 2 Coxwell Hall & Mews Nursing Home H57-H08 S27145 Coxwell Hall & Mews V222602 160505 Stage 4.doc Version 1.30 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. Standard 26 13 Regulation 13[3] 16[2][b] Requirement The home’s sluicing disinfector must be repaired or replaced if necessary. The home must provide residents/patients with a payhone. None. Timescale for action 31/07/05 30/07/05 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. 3. 4. 5. 6. Refer to Standard 24 26 37 38 19 Good Practice Recommendations None. Implement the 2005-06 refurbishement plan. Investigate the source of the unpleasant smell in the Mews and take action to address it. Ensure that care plans are kept individually. Highlight to staff the safety issue identified. Renovate/replace worn furniture and paint and protect chipped paintwork. Coxwell Hall & Mews Nursing Home H57-H08 S27145 Coxwell Hall & Mews V222602 160505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Burgner House, 4630 Kingsgate, Cascade Way, Oxford Business Park South, Cowley, Oxford, OX4 2SU 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 Coxwell Hall & Mews Nursing Home H57-H08 S27145 Coxwell Hall & Mews V222602 160505 Stage 4.doc Version 1.30 Page 23 - 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. 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