Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Downs Cottage 183 Great Tattenhams Epsom Downs Epsom Surrey KT18 5RA The quality rating for this care home is:
two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Patricia Collins
Date: 2 8 0 8 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home
Name of care home: Address: Downs Cottage 183 Great Tattenhams Epsom Downs Epsom Surrey KT18 5RA 01737352632 01737371068 care@downscottage.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Norma Thomas Type of registration: Number of places registered: Mrs N Thomas,Mr D Thomas care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Of the 23 registered users, one may be between 60 and 65 years of age, within the categories MD (mental disorder) or DE (dementia). Out of the 23 (twenty three) registered , they maybe either within the categories mental disorder/older persons MD(E) or dementia older persons DE(E). Date of last inspection Brief description of the care home Downs Cottage is a care home with nursing for older people including people with dementia and mental disorders. The providers are qualified nurses and are directly involved in the homes management and operation. Care Homes for Older People
Page 4 of 30 Over 65 0 23 23 23 0 0 Brief description of the care home This two-storey building has been converted and extended over the years. The domestic style and character of the building has been preserved. Car parking facilities are provided and a spacious, enclosed garden with ramped access to a furnished patio. Bedroom accommodation is on the ground and first floor and part accessible by chair lift. Most bedrooms are for single occupancy though some shared rooms are available. Most have en suite facilities and all have wash hand basins and emergency call bells. Communal living areas are on the ground floor and comprise of a combined lounge/dining room and separate lounge. Assisted bathing facilities and hoists are available. The home is within walking distance of shops and other community amenities in the village of Tattenham Corner village. It is served by public transport. Care Homes for Older People Page 5 of 30 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means people using the homes services experience good quality outcomes. Fees range from 551 Pounds to 897 Pounds per week. Date of last inspection: 22nd August 2007. The inspection visit was unannounced, forming part of the key inspection process using the Inspecting for Better Lives (IBL) methodology. It was undertaken by one inspector in just over five hours. The report will say what we found as it is written on behalf of the Commission for Social Care Inspection (CSCI). Care Homes for Older People
Page 6 of 30 Both providers were present for most of the inspection and in their absence the inspection was facilitated by nurses in charge of the home. Judgements about how well the home is meeting the national minimum standards for older people and quality of the care are based on the cumulative assessment, knowledge and experience of this home since its last key inspection. We have taken account of information supplied by the provider, one of whom is the registered manager, in the homes annual quality assurance assessment. This self-assessment focuses on how well outcomes are being met for people using services. It also gave us some numerical information relating to the home. We also considered feedback received in five survey questionnaires from a care manager, general practitioner, two relatives and staff member. The inspection process incorporated a tour of the garden and premises, visiting all communal areas, the kitchen, utility room, offices and bedrooms. Records and policies and procedures were sampled. Care practice, medication administration, the serving of lunch and a group activity was observed. Discussions took place with some people using services, the providers, staff, a visiting general practitioner, an activities therapist and a visitor. Judgements about the state of well being of people using services who we were unable to communicate with are based on observations of their body language and general appearance; also their interaction with staff and their environment. We reviewed their records and had discussions with a general practitioner, staff and a visitor. We wish to thank all who contributed information and participated in the inspection process. Also the people using the homes services, the providers and staff for their time, hospitality and cooperation during the visit. What the care home does well: The homes management understands the importance of having sufficient information when choosing a care home. A range of information is prominently displayed by the visitors register. This includes a statement of purpose specific to the home and the group of people cared for. A service users guide details what prospective people using services can expect and provides a clear account of the homes services and facilities, about staff and their training and how to make a complaint. The latest inspection report is also displayed. A comprehensive needs assessment is always carried out prior to admission. This is usually carried out by the providers though some times by staff with the necessary skills. The assessment focuses on achieving positive outcomes for prospective people using services. This ensures the facilities, staffing and specialist services provided by the home meet ethnic and diversity needs of each individual. Prospective people using services and their representatives can therefore have confidence that the home can meet their needs. A plan of care is then drawn up and where possible this process is inclusive, involving people using services and their representative. Care plans set out details of the action to be taken by staff to ensure all aspects of health, personal and social care needs are met. These are kept under regular review and updated in response to any change in needs. Staff are trained to meet the health and personal care needs of people using services. The home has an efficient medication policy and procedure. Observations during the inspection and feedback from a general practitioner who completed a survey indicated the health of people using services is promoted. Arrangements are made to access health care services and other professionals as necessary. A relative told us in a survey that a general practitioner regularly visits. He stated he is always informed by staff of any health related issues and updated when he visits. He reported that nursing staff closely monitor his mothers needs. Nutritional screening is carried out and service provision includes wholesome meals, ensuring dietary needs and food preferences are met. A relative told us in a survey received that the standard of food at the home is very good. The atmosphere was warm and welcoming on the day of the inspection. A relative commented in a survey, I am very impressed with Downs Cottage, its atmosphere and the caring attitude of staff. Staff were observed to be friendly and skilled in their interaction with people using services. An individualised approach to meeting needs was evident. In discussion with a visitor whose mother had recently been admitted, it was positive to hear that she had every confidence in the home and staff. She visits weekly and has found that staff have a good understanding of dementia. She was very pleased with the constant interaction between staff and people using services. She compared this to her experience of her mothers former care home where she felt her mother had been excluded and isolated. It was her opinion that Downs Cottage was more suited to meeting her mothers complex needs and she was happy with her mothers bedroom. She said that staff couldnt do enough for her mother. Care Homes for Older People Page 8 of 30 A suitable activities programme is organised to ensure adequate and appropriate stimulation. This incorporates activity sessions provided by peripatetic activity therapists and some social events. On the day of the inspection a group activity took place after initial one to one time provided by the activity therapist. This took place in the lounge and care staff assisted and encouraged people using services to take part in the various floor games. The session was interactive, using music and songs to engage people and ended with a quiz. A relative told us in a survey that his mother enjoys the musical entertainment provided by the home. The home is clean and hygienic and the premises and grounds are well maintained. A relative commented in a survey that his mothers room is in good condition and the standard of cleanliness at the home always high. He expressed every confidence in the homes management and staff, commenting, I consider the running of the home to be of a very high standard. I am pleased that my mother is at Downs Cottage and she is receiving the high standard of care she requires because of her medical condition. What has improved since the last inspection? What they could do better: Since the inspection visit the providers have been proactive in their response to suggestions for further development and improvements. They have spoken with the activities therapists about a more individualised approach to activities. Specifically for individuals who find group activities a less that positive experience. The providers have also become members of the National Association for Providers of Activities for Older People. They have obtained activity resource materials to support the staff team in creating a socially stimulating environment. A shortfall in practice in medication administration has been addressed. A larger white board is now on order to be placed outside the kitchen so that the days menu can be displayed. It was positive to note that the providers are looking at various models to ensure end of life care plans are developed. The comments of a relative who would like itemised details of expenditure of personal money of a relative have been listened to by management. In future this information will be supplied to relatives who require the same for Court of Protection purposes. The providers have obtained dementia research and best practice information since the visit. They plan to incorporate these principles into the homes Care Homes for Older People Page 9 of 30 philosophy of care and care planning process. An order has been placed for additional orientating cues in the home environment. The providers had not notified us of pressure sores acquired by a person using services as required. Additionally a care plan had not been generated from a risk assessment that identified an individual at risk of falls. The confirmed their agreement to ensure both shortfalls are addressed. The providers recognise that the decor and carpet in the entrance hall is below standard. Improvement to this area is however planned following building work associated with the installation of a passenger lift later this year. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 30 Details of our findings
Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 30 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using services and their representatives receive information that enables an informed choice about the homes suitability. Admission decisions are based on the findings of comprehensive needs assessments, to be sure that needs can be met. Standard 6 was not inspected as the home does not provide intermediate care services. Evidence: The providers have produced a comprehensive statement of purpose specific to the home and to the groups of people for whom the home is intended. It clearly sets out the service objectives and philosophy and is supported by a service users guide. The guide details what prospective people using services can expect, giving a clear account of the specialist services provided, accommodation and facilities; also staff qualifications and experience and information about the complaint procedure. Both documents had been reviewed and developed since the last inspection.
Care Homes for Older People Page 12 of 30 Evidence: The homes management understands the importance of having sufficient information when choosing a care home. The statement of purpose, service users guide and latest inspection report are all prominently displayed in the reception area, accessible to visitors where they sign the visitors book. Prospective people using services and their relatives or representatives are invited to visit the home. There is opportunity to look round the building, speak with management and staff and read information about the home. This assist them in making an informed decision about the homes suitability. In discussion with a relative of a person using services at the time of the visit, positive feedback was received about the homes pre-admission procedures. We were told how impressed she had been with the care practice observed at the time of viewing the home. Noting however that this relative was unaware of how care homes are regulated and that inspection reports and quality star ratings for care services are in the public domain it was suggested that time be set aside during pre-admission visits to ensure people are fully informed in these matters. This will enable an informed choice of home. The home has a clear admission criteria. The admission policy and procedures are underpinned by an equal opportunities policy. Pre-admission assessments are carried out by the provider, manager or staff nurses who have the necessary competencies and skills. The process is inclusive and focused on achieving positive outcomes for the individual. This ensures the homes facilities, staffing and specialist services meet individual needs and cultural and diversity needs are identified. The homes management is efficient in obtaining a summary of any assessment undertaken by care management or other agencies. Care Homes for Older People Page 13 of 30 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and personal care delivery is based on individual needs assessments and set out in a plan of care. The principles of respect, dignity and privacy are put into practice, including the management of death and dying. Medication policies and procedures ensure the health and welfare of people using services. Evidence: Requirements made at the time of the last inspection had been met. This action had improved the organisation of care documents and further developed the range of assessment tools. These now incorporated medication assessment of risks relating to ability for people using services to self-medicate, also assessments for people to access their wardrobes, drawers and doors. The use of a recognised nutrition screening tool had been implemented and nurses had received training in its use. A weight monitoring system continued with due diligence. Care plans now incorporated choice of gender of staff involved in the delivery of intimate personal care. A key worker system was operating and photographs of key workers were displayed in
Care Homes for Older People Page 14 of 30 Evidence: a public area. Key workers have delegated responsibility for care planning and reviews and the manager monitors and audits their practice. The care plans sampled had been generated from comprehensive needs and risk assessments. The care planning process was inclusive, involving people using services and their representatives, where possible. Care plans were up to date and overall reflected the current and changing needs of people using services. They incorporated their preferred form of address and information about special communication needs and of aids and equipment necessary to meet individual needs. A person-centred approach to care planning was evident. This included taking account of life-history information, personal likes and dislikes, leisure interests, and peoples spirituality; also recording how cultural, diversity personal and health care needs are to be met. Care notes were in adequate detail to ensure an audit trail of care delivery. Care and attention had been given to the general appearance of people using services. The care practice observed demonstrated staff awareness of the individual needs of the people in their care. We were unable to communicate with some people using services due to their special needs or understand their non-verbal forms of communication. Judgements about their wellbeing have been based on their appearance, body language and behaviours, also on observations of their interaction with staff and their environment. A visitor was very complimentary about staff and the care her mother had received since her recent admission to the home. She expressed confidence in the skills and empathy of staff, stating, they truly understand my mothers needs and I feel she is in the best place. She expressed the view her mother was receiving the best care possible and her needs were being met. She was also very pleased with staff practice in using life history information in their everyday interactions with her mother, using recall and reminiscence techniques to stimulate conversation. The home works closely with general practitioners and other professionals. The evidence for this was in records examined; also comments in surveys received from a general practitioner and care manager. This ensures a good standard of care and quality of life for people using services. Staff are trained and competent in meeting health and personal care needs. Those consulted demonstrated insight into the views and preferences, the mood and sense of well-being of the people they care for. The records viewed and discussions with staff confirmed constant monitoring for signs of pain and distress and other symptoms. This ensured people using services receives the care they need. Staff had received infection control training and good practice infection control procedures were being followed. The home was found to have robust pressure sore prevention risk assessments, ensuring appropriate intervention is recorded in a plan of care, including pressure
Care Homes for Older People Page 15 of 30 Evidence: relieving equipment. Despite best practice, a person using services had developed pressure sores since her recent admission. These had been medically assessed and their continuing assessment, treatment and outcome was well recorded. Staff communicate changes in needs or other significant information to relatives as necessary. We know this is the case from the positive feedback received from relatives surveyed. Examples of comments received were, The nurses closely monitor my mothers needs and I am regularly updated during visits. The staff are always available when needed. The GP regularly visits and I am informed of any health changes or any problems, Mother receives the medical support needed. It was concluded on the basis of all observations that the health and personal care needs and preferences of people using services were being met. Relatives and friends are welcome to visit at any reasonable time. Their positive contribution to the wellbeing of people using services is recognised and valued by the homes management and staff. The medication policy, procedure and practice guidance is efficient and nurses have access to this written information. The storage, recording, administration and disposal of medication overall protects people using services. A shortfall in medication practice at the time of the visit was discussed with management and remedial action reported. The home has a monitored dosage medication system and had recently changed its supplier. Nurses were stated to have received recent medication training from the new supplier. Policies and procedures are in place for the management of dying and death. These encompass dignity, privacy, choice, spirituality and ensure nursing needs are met. Staff confirmed liaison with medical and palliative care professionals in these circumstances. Discussion took place with the providers about the need to consider advanced end of life care planning. The providers have since reported they have been looking at the various models for end of life care. It was confirmed that some senior nurses had received palliative care pain control training. Care Homes for Older People Page 16 of 30 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the homes services are treated as individuals by staff. Arrangements are in place to provide stimulating social activities appropriate to their needs, age and culture. People using services are supported in maintaining contact with family and friends and are offered a balanced and varied diet. Evidence: The homes ethos recognises the therapeutic benefits of being mentally and physically active. Staff were attentive to people using services during the inspection visit, engaging individuals in social interaction in the lounge. Newspapers, magazines and books were available in this area and the television was on for most of the visit. This was at the expressed wish of two people using services who were taking an active interest in the programmes. A peripatetic activities therapist visited on the afternoon of the inspection. She facilitates a stimulating and enjoyable group activity. This was part of the homes routine social activities programme. A second activity organiser from the same organisation also visits once a week. The activity session took place in the lounge where all of the people using services were sat. Initially she engaged people in the
Care Homes for Older People Page 17 of 30 Evidence: activities by going round the room giving each person some one to one time. She engaged them in conversations and an interesting activity. The session progressed to small group activities with floor games. Care staff also participated, encouraging and supporting people using services to join in. The atmosphere was stimulating and there was much fun and laughter. Some people using services who had earlier appeared withdrawn, were noted to be watching and taking an interest. The activity session incorporated music with an impromptu sing-along and one person enjoyed a dance with the therapist. A quiz drew the session to a close. Most people using services appeared to have benefited from the session, as evidenced by their smiles and other body language and behaviours. There were however one or two people who had clearly not found the experience comfortable and at times become agitated during this period. It was agreed with the providers that in future the nurse in charge on the days of group activities would assess the mood and wishes of these individuals. They should be offered the choice of sitting somewhere quieter or where they can continue watching television programmes uninterupted with staff supervision. There are well established community links and the home is conveniently located within walking distance of a parade of shops. The provider has told us that staff offer to go out with people using services on a one to one basis however some do not wish to. Others go out occasionally with relatives and friends. Since the visit the provider has told us that further recreational tools have been obtained for staff to use to enhance social and leisure opportunities. The providers have also become members of the National Association for Providers of Activities for Older People (NAPA). A number of social events had taken place since the last inspection, to which relatives and friends of the home had been invited. These included a Christmas party and summer barbecue with dancers and music. Both events had been well attended and enjoyable occasions. A hairdresser visits every two weeks and was at the home on the day of the visit. Areas of discussion with management included ways of enhancing the environment through furnishings, decor and signage. This may reduce confusion and improve orientation for people with dementia. Since the inspection visit the provider has reported a number of developments in this area including bedroom, bathroom and toilet colour signage. It was good to note staff maintaining the orientation board up to date in the lounge. This board displayed information about the date, day, weather and the next meal, for example lunch time. A couple of people using services were noted to frequently read it out loud and take note of this information, particularly the next mealtime, adding structure to their day. Noting they were not aware of meal choices as the menu board did not contain this information, it was suggested to the providers that this be also included on this board. The providers have since confirmed they have
Care Homes for Older People Page 18 of 30 Evidence: ordered a larger white board for outside the kitchen for this purpose. Menus had been viewed by a community dietitian in the past and the homes management would like to pursue further input from community dietitians. Evidence was seen of recent assessment and input from a dietitian into the needs of a person using services. Menu planning takes account of food preferences and any cultural or dietary needs. The menus sampled offered a choice of food, were varied and included the option of soft and pureed diets, based on individual needs. The manager confirmed routine fortification of foods with natural ingredients. Two cooks are employed, who work opposite each other and cover each others days off and leave. The kitchen was clean and all appliances working, the extractor fan on the cooker hood having been replaced. The providers have utilised the Better Food, Better Business document from the Environmental Health Department to enhance the homes food hygiene policy and practice. The need for the part-time cook to attend food hygiene refresher training was discussed. At the outset of the inspection an appetising, nicely presented, two course roast dinner was served, followed by a dessert. People using services were eating their meals, with staff assistance as necessary. Some people were sat at dining tables and others had their meals served on small tables in front of their armchairs. The atmosphere was relaxed and unhurried. Staff practice would be improved if staff ensured they were seated and at the same level as the people they were assisting. Care Homes for Older People Page 19 of 30 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an accessible complaint procedure. Policies and procedures protect people using services from abuse, neglect and self-harm. Evidence: The home has a robust complaint procedure. This is given to relatives and advocates of people using services and is prominently displayed. A complaints and compliments box is available at the home and a complaint record used to document complaints and the action taken. We have not received any complaints about the home since the last inspection. The records viewed indicated no complaints had been received by the homes management for the same period. The homes policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. These feed into Surreys multi-agency safeguarding procedure, a copy of which is available in the home. Discussions with the manager and senior staff established clarity of these procedures and of the action they must take in response to an allegation or suspicion of abuse. The staff training records sampled confirmed staff had received safeguarding adults training and refresher training. Staff were aware of indicators of abuse and of their responsibilities and rights under whistle blowing procedure. Staff were aware and understood what restraint is and alternatives to its use in any form are always looked for. Observations confirmed transparency of practice and record keeping in the use of restraint, where this is
Care Homes for Older People Page 20 of 30 Evidence: necessary in the best interest of people using services. The type of restraint was recorded and relatives and professionals consulted and were in agreement. Since the last inspection there had been one safeguarding adults incident concerning a fatal accident and this was fully investigated. The safeguarding team and coroner were satisfied that the accident could not have been prevented. The provider has since made alterations and changes in the area where the accident occurred as an additional precautionary measure. Staff recruitment and vetting procedures ensure people unsuitable to work with vulnerable adults are not employed. Care Homes for Older People Page 21 of 30 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is domestic in scale and character, hygienic and comfortable, promoting the privacy, dignity and autonomy of people using services. Evidence: A tour of the building and grounds took place. All communal areas and bedrooms were inspected, also the kitchen, laundry and a sample of bathrooms and toilets. Cleanliness and hygiene was of a good standard and odour satisfactorily managed. Infection control procedures and practice were effective and subject to regular audits. The providers have moved to a new clinical waste and sharps disposal company since the last inspection. There is an ongoing programme of refurbishment and upgrading. Areas of discussion with the providers included their intention to install a passenger lift before the end of the year. The lift has been selected and building work is planned to make the necessary structural changes. This will reduce the number of bedrooms, losing a single room on the first floor and converting a shared bedroom to a single room on the ground floor. The proposed lift will serve bedrooms on the first floor to one side of the premises only, two first floor bedrooms will remain accessible by stairs on the other side of the building. Consideration may be given to fitting the chair lift to this staircase if necessary. The providers are also planning a conservatory in due course and may
Care Homes for Older People Page 22 of 30 Evidence: then convert a small lounge into a single bedroom. New carpets had been fitted in the lounge dining area and in some bedrooms. The providers are aware that the appearance of the main entrance and carpet in this corridor does not do justice to the rest of the environment. This area is due to be redecorated and re-carpeted following completion of the building programme. The providers reviewed the adequacy of ventilation in bedroom 5 as requested at the time of the last inspection. A deflector had been erected above the kitchen fan outlet. Extractor fans had been fitted in the boiler room and kitchen. The homes enclosed garden provides an attractive outlook from the lounge and some bedrooms. It was observed to be well maintained by a part-time maintenance person who is also responsible for health and safety risk assessments. There is a furnished patio area and staff were stated to accompany people using services when in the garden, to ensure their safety. Care Homes for Older People Page 23 of 30 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff recruitment and vetting procedures are robust. People using services benefit from a suitably trained and skilled workforce that is sufficient in numbers to meet their individual needs. Evidence: The home has a good record of staff retention. The team is relatively stable and there is a core group of staff who have been employed at Downs Cottage for many years providing continuity of routines and care. Observations of staff rotas and feedback from staff confirmed there are consistently enough staff on duty to enable them to meet the needs of people using services. Staffing levels are monitored and a high level of importance is evidently placed on ensuring a balance of requisite skills, knowledge and experience within the team. Both providers have mental health nursing qualifications and the provider/manager is also a registered general nurse. The home employs sufficient registered general nurses and one is currently studying for qualifications in mental health nursing also the registered managers award. A night nurse was stated to have a special interest in wound care and up to date knowledge in this area of practice, providing advice and support to colleagues. The staff rotas confirmed that staffing levels were being consistently maintained. Staffing levels and skill mix was noted to be determined by dependency levels and the complex layout of the premises. The rota is planned to have sufficient gender mix of staff. Needs
Care Homes for Older People Page 24 of 30 Evidence: assessments identify whether people or their advocates have gender preference in the delivery of intimate personal care. The homes recruitment policy is based on equal opportunities legislation to ensure compliance with immigration and anti-discriminatory laws. Recruitment practice was examined by sampling new employees records and found to be satisfactory. A change has been made to the job application form based on discussions at the time of the inspection. Both providers have training qualifications and are highly committed to staff development and training. New staff receive an appropriate induction and mandatory training is provided in-house, using a range of training materials. The providers use the services of The Learning Hub through the Surrey Care Homes Association, who are training a further three care assistants towards achieving NVQ Level 2 qualifications. The training is web based and staff use laptops in the home with the trainer. The providers have installed a WiFi broadband internet network to facilitate this. The home uses BVS training materials for in-house training in the form of DVDs, handouts, assessments and certificates. The home has an established staff supervision structure. All supervisors attended a tailored supervision programme earlier this year, facilitated by an external training and consultancy company. Staff have individual personal development plans and their learning and development needs stated to be identified and agreed during supervision sessions. Care Homes for Older People Page 25 of 30 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes management and administration is efficient and its operation is based on openness and respect. Quality assurance systems are effective and ensure the home is run in the best interest of people using services. Their rights, safety and welfare are overall protected by the homes policies and procedures. Evidence: The homes management has ensured compliance with all statutory requirements made at the time of the last inspection. The providers are both involved in the homes management and administration. They have clearly defined roles and areas of responsibility. The provider/ manager has the necessary qualifications and experience and together they provide staff with direction and leadership. The homes management is working to continuously improve and develop service provision. The best interest of people using services was stated by the providers to be at the core of their decisions. Good team work was in evidence within the senior management group, creating a positive atmosphere for people using services and staff.
Care Homes for Older People Page 26 of 30 Evidence: The providers are proactive in ensuring their own continuous training and development. They engage in a wide range of relevant meetings and training events in the care sector. This ensures their practice is updated and the homes management and philosophy is non-insular. The manager has been receiving support and mentoring from an external adviser, which she has found helpful. Consideration is being given to a change in management responsibility for the homes day to day management. Work is in progress to re-define and scope the managers role. The providers were clear that they plan to continue their active involvement in the homes operation. Administration records were well organised and maintained to a good standard. Policies and procedures are updated regularly. The personal allowances for people using services are not kept at the home. Money spent for people using services is collected in arrears from relatives and advocates. Discussion took place with the provider about a comment from a relative who returned a survey questionnaire. The need for a detailed breakdown of expenditure of personal money of people using services was requested. The provider has confirmed his instructions to the homes administrator to produce itemised invoices for those who require the same. The home works to a clear health and safety policy, has a consistent record of compliance with relevant legislation and closely monitors its own practice. Following the fatal accident last year on the stairs, management has reviewed the falls prevention policy and procedures. Changes have been made to signage and safety enhancement of stairs. The homes management mostly ensures notification of reportable occurrences. The providers were referred to new guidance about notifications on our website to ensure the method used for notifications is in accordance with data protection legislation. The providers were reminded of the requirement to notify us of pressure sores of grade 2 and above, having found someone using services with pressure sores and of infections, for example MRSA. The homes management fully recognises the importance of the annual quality assurance assessment and has used this to inform its own quality assurance system. A quality survey was carried out and the summary of the outcomes viewed. Overall the findings were positive and areas for improvement, specifically laundry, staffs response to phone calls and cleanliness had been taken seriously and remedial action instituted. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations
These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - 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!
