CARE HOMES FOR OLDER PEOPLE
East Cosham House 91 Havant Road East Cosham Portsmouth Hampshire PO6 2JD Lead Inspector
Richard Slimm Unannounced Inspection 17 October 2005 10:00a 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 East Cosham House DS0000012360.V255487.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. East Cosham House DS0000012360.V255487.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service East Cosham House Address 91 Havant Road East Cosham Portsmouth Hampshire PO6 2JD 023 9232 1805 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) Mrs P Drabble Mr G Drabble Mrs Kim Ina Shelton Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (24), Old age, not falling within any other category (24) East Cosham House DS0000012360.V255487.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 25th April 2005 Brief Description of the Service: East Cosham House is registered with the Commission for Social Care Inspection (CSCI) to accommodate up to 24 residents who are over 65 and have an age related mental health-care need. The home is a large detached property and is situated up a short drive; it is just off the main road through East Cosham and provides easy access to the town centre. The home has two gardens, one that is enclosed to the rear of the premises, with seating areas for residents. There are 18 single and 3 double bedrooms. The home has three communal lounges and a dinning room, which are all pleasantly furnished and decorated providing a valuing environment for the people living there. There is parking for up to 6 vehicles. East Cosham House DS0000012360.V255487.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place between the hours of 09.45 am and 4 pm on the 17/10/05. The day was spent visiting service users around the communal areas of the home and interviewing them in order to establish their views of the quality of service provided by the home, the inspector also discreetly observed the lunch period, and care interventions including the administration of medication. The inspector checked records and other relevant documentation, interviewing care and management staff. Both residents and staff spoken to, made positive comments about the home. The commission had received anonymous concerns about the levels of dependency of some residents at the home, and this was one area of focus during the visit. What the service does well: What has improved since the last inspection? What they could do better:
There was evidence that a number of residents had become increasingly frail, from both a physical and mental frailty, perspective, and a number of residents were found to be of a higher dependency than that normally expected within a care home. Some residents were receiving regular input from the community health care team, in order to support sustaining these placements safely.
East Cosham House DS0000012360.V255487.R01.S.doc Version 5.0 Page 6 There is a need to carefully monitor these issues, in order that adequate staffing resources are put in place to ensure that the needs of the whole resident group are met across any 24-hour period. While the home had employed extra staff at tea times, there was concern voiced by some staff and residents that early morning, lunchtimes and bedtimes can prove difficult for staff to fully promote resident choice. There were also fewer opportunities recently to spend quality time with residents, due to the business of dealing with more disabled residents practical support needs. There was also evidence of practices that may compromise cross infection safety procedures, with care staff moving across from care related tasks to food preparation and food serving tasks. There was also a bout of stomach related illness at the home at the time of the visit. There were weaknesses identified in staff supervision, and evidence that individual supervision sessions were not being provided to the frequency identified in the standards. There is still a need to improve the quality and detail of information within residents’ care plans, especially where there are risk associated issues and behaviours that challenge the service and staff on a regular basis. Care needs to be taken to ensure that staff interventions do not add to the incidents of challenging behaviours, and daily monitoring notes need to record facts, especially where there are incidents of verbal, physical or racial abuse arising. Care plans need to make allowances for residents needs, wishes and understanding, and enable staff to adopt a range of strategies that increase flexibility, allowing residents to take as much control as is safe and practicable. It may be useful to introduce some dementia mapping to the home, which could be linked to monitoring dependency and outcomes for residents living at the home. 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. East Cosham House DS0000012360.V255487.R01.S.doc Version 5.0 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 East Cosham House DS0000012360.V255487.R01.S.doc Version 5.0 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 Residents have their needs assessed prior to admission. Where residents’ needs change the home does not currently reassess adequately in order to ensure care records are fully up to date. EVIDENCE: A sample of 3 residents’ care records, including assessments, planning and review systems were inspected. It was possible to interview one of these residents at the time of the visit, who confirmed that the home does everything they can to make her feel at home. The home has a pro-forma to carry out personal profiles with residents as part of assessment, this system attempts to ensure the quality of information about residents’ lives prior to entering the home is in place prior to the development of care plans. Care assessments could be developed further, especially in the area of behaviours that challenge and focus on mental health care needs. Residents were found to be contented, but given the degree of confusion many were not fully aware of care records held about them. Staff members were able to demonstrate an awareness of the importance of care planning systems in regard to promoting consistency and accountability. A number of care reviews had not been carried out within the timescales recommended. Staff would benefit from further
East Cosham House DS0000012360.V255487.R01.S.doc Version 5.0 Page 9 training in the ongoing development and completion of care records at the home. East Cosham House DS0000012360.V255487.R01.S.doc Version 5.0 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): 7-8-10 Residents had individual plans of care. Care plans were not fully specific, especially in areas where behaviours may challenge the service, and staff interventions to reduce challenges. Care plans, and management systems, did ensure residents health care needs were identified and met. Residents were treated with respect, and issues of privacy appeared to be acknowledged, promoted and protected with residents and where needed for residents. EVIDENCE: Each Resident has a plan of care. Care plans still need to be made more specific, in such areas as behaviours that challenge the service. It is important to ensure that where challenges arise these issues are clearly recorded and transferred to plans to assist staff in providing consistent support that does not increase the likelihood of adverse reactions from residents. It is likely that the use of care planning by staff in addressing behavioural issues is likely to be new to them, consequently some training may be needed. Residents were found to be contented, but given the degree of confusion were not fully aware of care records held about them. Staff members were able to demonstrate an awareness of the importance of care planning systems in regard to promoting consistency and accountability, but, as identified above, some staff training needs were identified in this area. There is a need to ensure that monthly care
East Cosham House DS0000012360.V255487.R01.S.doc Version 5.0 Page 11 monitoring reviews take place and action taken to update plans based on these reviews, especially for those residents who’s needs have increased. One resident spoken to stated that the home do everything they can to make her feel at home, and she spoke highly of the staffs’ efforts. Throughout the visit it was evident that the staff team, were aware of issues of privacy, and appropriate action was taken to promote and/or protect resident privacy. As identified above a number of residents are now very frail and vulnerable, and it may be useful for some dementia mapping to be carried out in order to identify any gaps in services that need to be addressed, and to further measure quality of life outcomes for more confused residents. East Cosham House DS0000012360.V255487.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12-13 Residents are provided with support to lead their own lives as far as possible. The home needs to review information about one resident’s religious needs. Contact from outside of the home is encouraged and supported. EVIDENCE: Assessment information about one resident had identified the wrong religious persuasion. This will need to be updated. The home attempts to provide opportunities for residents to satisfy their individual social, cultural and religious interests and needs, however, there are a number of challenges to achieving this with more dependent residents. As mentioned above it may be useful if the home carried out some dementia mapping, in order to more accurately assess outcomes for more confused residents. The outcome of such an exercise could be very useful to the future meaningful development of the home. Residents confirmed that they were able to have visitors at any reasonable time, and were happy with visiting arrangements. It was not possible for the inspector to speak to any visitors during this unannounced visit. The manager confirmed that visitors are very welcome, based on the residents wishes, and the visitors log indicated a steady flow of visitors to and from the home. East Cosham House DS0000012360.V255487.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Systems are in place to ensure any concerns or complaints are listened to, taken seriously and acted on. EVIDENCE: The inspector had received concerns from an anonymous source prior to the inspection. The manager indicated that she had been made aware of these concerns and the matter was now being addressed. The inspector focused on dependency levels at the home during this visit, as this issue was the area of concern. The home has a complaints procedure, and a log of complaints. East Cosham House DS0000012360.V255487.R01.S.doc Version 5.0 Page 14 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): 26 The home was safe clean and well maintained, providing a valuing environment to residents. Poor staff practices in the area of infection control and food hygiene were evident. EVIDENCE: While the home was well presented and cleaned to a good standard, it was noted that during busy times of the day staff members move from caring tasks to food handling tasks without adequate reference to current best practice, and the home’s policies and procedures. This has been addressed during tea times, and the commitment of the cook to come into the home early in the morning has also assisted, however, at other times staff accepted that they move across from caring tasks to food handling tasks without adequate precautions to cross infection. It was also noted that care staff were in food preparation areas when food was being prepared, and the kitchen is sometimes used as a thoroughfare, contrary to best practice. The manager was reminded of the need to ensure that when care staff members need to access the staff area to the rear of the kitchen, they do not do so by walking through the kitchen. Some residents had stomach upsets at the time of the visit.
East Cosham House DS0000012360.V255487.R01.S.doc Version 5.0 Page 15 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 Staff deployment was in need of review at busier times of the day. Best practice is followed in the area of staff recruitment and selection. Supervision sessions with individual staff were not meeting the standards. Staff training in care record development and maintenance and cross infection is needed. EVIDENCE: The home has clear staff rosters. Staffing levels were in line with recommended levels. Some staff felt increasingly pressurised at busier times of the day, when they believe it is difficult to fully promote resident choices. This issue has been partly addressed by the introduction of a teatime worker. Over some months a number of residents have become increasingly frail, and this has led to a decrease in the availability of staff to spend quality time with other residents. Residents spoke highly of the staff team. Staff members were observed interacting well with residents, and providing sensitive support. Staff members now need increased training in the development and maintenance of the homes’ care record systems. There are two waking staff members. In addition to care staff the home employs ancillary staff including cooks, domestics, maintenance and gardener. The home uses a thorough recruitment and selection system that meets the legal requirements and provides safeguards for residents, by ensuring all staff receive appropriate checks. While there is a stated commitment to the ongoing training and development of the staff team, a recommendation made in the last report will be repeated in the area of staff training. Care staff members were observed using the kitchen as a thoroughfare, and other poor practices in the area of infection control were discussed and observed.
East Cosham House DS0000012360.V255487.R01.S.doc Version 5.0 Page 16 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): 31-38 The home has a registered manager, who is keen to work with the commission and other stakeholders to provide the best quality of service possible. The Health and safety of residents could be further promoted by improving infection control practices at the home. EVIDENCE: The homes’ manager is keen to work with the CSCI in the ongoing development of the service. Residents spoken to confirmed that they are made to feel at home. There was evidence to support the view that staff members need updated training in food-hygiene and infection control. The manager will need to liaise with an environmental health officer to seek guidance in the area of infection control. It was noted that service contracts are in place for the maintenance of the central heating, chair lifts, electrical items/systems and bath hoists/chair. A resident and staff members confirmed that there are regular fire drills at the home. Residents confirmed that they felt safe living at
East Cosham House DS0000012360.V255487.R01.S.doc Version 5.0 Page 17 the home. Samples of policies and procedures were inspected, and systems of quality assurance continue to develop at the home. East Cosham House DS0000012360.V255487.R01.S.doc Version 5.0 Page 18 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 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 3 X X X X X X 1 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 3 East Cosham House DS0000012360.V255487.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? NA STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP30OP26 Regulation 12-13 Requirement The registered persons must consult the environmental health department with regard to guidance to promote best staff practices in the areas of food hygiene and infection control. Appropriate staff training will be put in place in line with the recommendations of the environmental health department. The registered manager must make arrangements to provide professional supervision to staff at least six times per year. Supervision should cover as a minimum – all aspects of practice; the philosophy of the home and how this will be reflected in outcomes for residents and the career development needs of the staff member. Timescale for action 01/12/05 2 OP36 18 01/12/05 East Cosham House DS0000012360.V255487.R01.S.doc Version 5.0 Page 20 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 Refer to Standard OP30OP7O P3 Good Practice Recommendations It is recommended that the registered persons ensure that care assessments/plans are completed with as much input as possible from residents and/or their representatives. Care plans need to be specific and address issues, meeting needs and wishes as identified in assessments and profiles. Plans will need to address such issues as behaviours that may challenge, and how staff are to deal with residents who may display verbal, physical or racial abuse toward others. Plans will need to make allowances for residents understanding, but should also address issues in a professional and clear manner, avoiding interventions that may increase adverse behaviours in more confused residents. Care staff will need to work consistently from the plans clear instructions/guidance. Daily records will need to monitor closely the levels of dependency of the resident and where necessary such issues will need to be reviewed and appropriate action taken. Daily records will also need to state factual record of events, in clear specific terms. Staff will need further trianng input in this area of practice. It is recommended that dementia mapping is introduced to the home. 2 OP12 East Cosham House DS0000012360.V255487.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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